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Meta-Analysis
. 2016 Aug 22;113(33-34):545-51.
doi: 10.3238/arztebl.2016.0545.

The Treatment of Critically Ill Patients With Acute Cholecystitis

Peter C Ambe  1 , Sarantos Kaptanis, Marios Papadakis, Sebastian A Weber, Stefan Jansen, Hubert Zirngibl
Affiliations
Meta-Analysis

The Treatment of Critically Ill Patients With Acute Cholecystitis

Peter C Ambe et al. Dtsch Arztebl Int. .

Abstract

Background: Besides cholecystectomy (CC), percutaneous cholecystostomy (PC) has been recommended for the management of critically ill patients with acute cholecystitis. However, solid evidence on the benefit of PC in this subgroup of patients is lacking.

Methods: In accordance with the PRISMA guidelines for systematic reviews, we systematically searched the Cochrane Library, CINAHL, MEDLINE, Embase, and Scopus for relevant studies published between 2000 and 2014. Two investigators independently screened the studies included.

Results: Six studies with a total of 337 500 patients (PC 10 045, CC 327 455) were included for meta-analysis. Significant differences in favor of CC were recorded with regard to the rate of mortality (OR 4.28, [1.72 to 10.62], p = 0.0017), length of hospital stay (OR 1.41, [1.02 to 1.95], p = 0.04), and the rate of readmission for biliary complaints (OR 2.16, [1.72 to 2.73], p<0.0001). There was no statistically significant difference between both intervention arms with regard to complications (OR 0.74, [0.36 to 1.53], p = 0.42) and re-interventions (OR 7.69, [0.68 to 87.33], p = 0.10).

Conclusion: The benefit of percutaneous cholecystostomy (PC) over cholecystectomy (CC) in the management of critically ill patients with acute cholecystitis could not be proven in this systematic review.

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Figures

Figure 1a
Figure 1a
Forest Plot of mortality after intervention (unadjusted mortality analysis presented here). OR, odds ratio; 95% CI, 95% confidence interval; RE model, random-effects model
Figure 1b
Figure 1b
Forest Plot of complication rates (unadjusted odds ratios presented here). OR, odds ratio; 95% CI, 95% confidence interval; Compl., complication rate; RE model, random-effects model
Figure 2a
Figure 2a
Forest plot of length of stay in hospital (unadjusted odds ratios) LOS, length of stay; OR, odds ratio; 95% CI, 95% confidence interval; RE model, random-effects model
Figure 2b
Figure 2b
Forest plot of re-intervention following PC or CC (unadjusted odds ratios).OR, odds ratio; 95% CI, 95% confidence interval; RE model, random-effects model
Figure 2c
Figure 2c
Forest plot of readmission for biliary reasons following management with PC or CC (unadjusted odds ratios). RA, readmission; OR, odds ratio; 95% CI, 95% confidence interval; RE model, random-effects model
eFigure
eFigure
Flow diagram for article selection and inclusion based on the PRISMA guidelines. PC, percutaneous cholecystostomy
See this image and copyright information in PMC

References

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    1. Ambe PC, Weber SA, Christ H, et al. Primary cholecystectomy is feasible in elderly patients with acute cholecystitis. Aging Clin Exp Res. 2015;27:921–926. - PubMed

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