Percutaneous cholecystostomy (PC) has emerged as a valuable alternative to early cholecystectomy for managing acute cholecystitis (AC) in high-risk patients, particularly those classified as grade II or III according to the Tokyo Guidelines (TG). However, the criteria for optimal patient selection and predictors of definitive surgical needs remain inadequately defined. This single-center, retrospective study included 30 patients who underwent PC for AC between 2022 and 2025. Patients were classified as having TG18 grade II or III AC. Demographic characteristics, clinical scores (American Society for Anesthesiologists ASA and Charlson Comorbidity Index), laboratory parameters (neutrophil-to-lymphocyte ratio NLR, platelet-to-lymphocyte ratio PLR, and systemic immune-inflammation index SII), length of hospital stay, intensive care unit (ICU) and total parenteral nutrition (TPN) needs, and outcomes, including 30-day and 12-month mortality, and the need for interval cholecystectomy, were analyzed. Patients with grade III AC exhibited significantly higher NLR and lower lymphocyte counts (P = .042 and P = .005, respectively). ICU admission, TPN requirements, and 12-month mortality rates were significantly higher in this group. Post-PC cholecystectomy was performed in 30% of patients, and those requiring surgery had higher ASA scores, experienced prolonged hospitalization, and an elevated mortality rate (P < .05). No major PC-related complications were observed. PC was a safe and effective alternative for high-risk patients with AC. However, many patients with higher ASA scores and severe grades still require surgery and experience higher mortality. Accurate patient selection, therefore, is essential to achieve better outcomes and avoid unnecessary procedures. These findings support personalized guideline-based decisions and identify clinical and laboratory factors that may predict the need for surgery and prognosis.
Kahraman et al. (Fri,) studied this question.