Percutaneous Cholecystostomy in Octogenarians with Acute Cholecystitis: Bridge to Surgery or Definitive Solution?

Background: Acute cholecystitis is a prevalent cause of emergency surgeries globally, particularly challenging in octogenarian patients due to their higher risk of comorbidities and surgical complications. This study aims to evaluate the efficacy and safety of percutaneous cholecystostomy as both a bridging and definitive treatment for acute cholecystitis in patients aged 80 and above. Methods: A retrospective analysis was conducted on 182 octogenarian patients treated for acute cholecystitis between 2017 and 2022. Patients were divided into two groups: those who underwent percutaneous cholecystostomy (n = 107) and those who received medical treatment (n = 65). Clinical, laboratory, and demographic data were analyzed. Statistical tests, including the Mann-Whitney U test and chi-square test, were used to compare the outcomes between the groups. Results: Out of 182 patients, 10 were excluded due to undergoing emergency cholecystectomy. Percutaneous cholecystostomy was performed on 107 patients (58.8%), while 65 patients (35.7%) received medical treatment. The percutaneous cholecystostomy group showed significantly higher CRP levels (p < 0.01), neutrophil counts (p = 0.046), and neutrophil-to-lymphocyte ratios (p = 0.007). The survival time was longer in the medical treatment group (18.74 ± 18.79 months vs. 10.77 ± 13.0 months, p = 0.03). However, the overall mortality rate was lower in the percutaneous cholecystostomy group (48.6% vs. 64.6%, p = 0.041). Conclusion: Percutaneous cholecystostomy appears to be a viable and safe alternative to cholecystectomy in octogenarian patients with acute cholecystitis, serving not only as a bridge treatment but also as a potential definitive solution. Given the advanced age and comorbidities of these patients, the likelihood of a second cholecystitis attack is minimal, supporting the use of percutaneous cholecystostomy as a long-term management strategy. Future large-scale studies are necessary to confirm these findings and further refine treatment protocols for this vulnerable patient population.