Early (≤4 Weeks) Versus Delayed (>4 Weeks) Interval Cholecystectomy After Percutaneous Cholecystostomy in High-Risk Acute Cholecystitis: A Real-World Surgical Reassessment Cohort

Background: Management of high-risk acute cholecystitis increasingly relies on percutaneous cholecystostomy (PC) as a bridging strategy when immediate surgery is not feasible; however, real-world surgical data guiding reassessment and timing of interval cholecystectomy remain limited. Understanding how timing decisions are implemented in routine hepatobiliary practice may provide clinically meaningful insight beyond traditional comparative analyses. Methods: This pragmatic single-center retrospective cohort included adult patients with acute cholecystitis initially managed with PC who subsequently underwent definitive cholecystectomy between January 2016 and December 2025. Patients were categorized according to surgical timing: early (≤4 weeks) or delayed (>4 weeks). Primary exploratory outcomes included operative duration and estimated blood loss, while secondary descriptive outcomes comprised conversion to open surgery, postoperative complications, and mortality. Analyses were conducted descriptively in accordance with STROBE recommendations. Results: Twenty-seven patients underwent interval cholecystectomy (15 early vs. 12 delayed). Earlier surgery descriptively coincided with shorter operative duration and lower estimated blood loss. Conversion to open surgery and postoperative complications occurred in both groups. Mortality events occurred exclusively in the delayed group; however, given the descriptive design and baseline clinical heterogeneity, no causal inference regarding surgical timing can be established. Conclusions: These findings provide practice-informing real-world surgical insight into multidisciplinary reassessment after percutaneous cholecystostomy and support individualized hepatobiliary decision-making rather than fixed temporal thresholds. Trial registration: Open Science Framework (OSF). Registration DOI: https://doi.org/10.17605/OSF.IO/GR5DT Clinical trial number: Not applicable.