Prognostic Factors and Predictive Models for Rates of Mortality and Morbidity Following Percutaneous Cholecystostomy: A Retrospective Cohort Study at Counties Manukau Between 2022 and 2024.

BACKGROUND Percutaneous cholecystostomy is a critical intervention for patients with acute cholecystitis who are unsuitable for immediate surgery, yet long-term outcomes and prognostic indicators remain poorly defined. This largest single-centre study in New Zealand has been performed to evaluate percutaneous cholecystotomy outcomes and to investigate key predictors of mortality and morbidity.

METHODS A retrospective cohort study of all patients undergoing percutaneous cholecystostomy between January 2022 and December 2024 was performed. Clinical, radiological and procedural variables were analysed. Primary outcomes were 30-day, 90-day and 1-year mortality; secondary outcomes included sepsis resolution, readmissions, drain-related complications and subsequent completion cholecystectomy.

RESULTS Among 115 patients, mortality was 7.8% at 30 days, 11.3% at 90 days and 25.2% at 1 year. Acute acalculous cholecystitis conferred a fourfold greater 1-year mortality compared with calculous disease. Acute kidney injury predicted early mortality, while cardiovascular comorbidities predicted late mortality. Sepsis resolved within 72 h in 81.7% of patients, though after-hours procedures were associated with lower success rates. Readmissions and drain-related complications occurred in over half of patients.

CONCLUSIONS Patients undergoing percutaneous cholecystostomy face a substantial disease burden, with high rates of complications, readmissions and late mortality. Percutaneous cholecystostomy should be framed as a palliative or temporising measure rather than definitive therapy and patients must be counselled accordingly so expectations are realistic. In suitable candidates, interval cholecystectomy remains essential for definitive treatment. In acute acalculous cholecystitis, percutaneous cholecystostomy should not be the main treatment; priority must instead be given to addressing the underlying systemic illness.