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| 1 | Operative complications and economic outcomes of cholecystectomy for acute cholecystitis显示文摘BACKGROUND Recent management of acute cholecystitis favors same admission(SA)or emergent cholecystectomy based on overall shorter hospital stay and therefore cost savings.We adopted the practice of SA cholecystectomy for the treatment of acute cholecystitis at our tertiary care center and wanted to evaluate the economic benefit of this practice.We hypothesized that the existence of complications,particularly among patients with a higher degree of disease severity,during SA cholecystectomy could negate the cost savings.AIM To compare complication rates and hospital costs between SA vs delayed cholecystectomy among patients admitted emergently for acute cholecystitis.METHODS Under an IRB-approved protocol,complications and charges for were obtained for SA,later after conservative management(Delayed),or elective cholecystectomies over an 8.5-year period.Patients were identified using the acute care surgery registry and billing database.Data was retrieved via EMR,operative logs,and Revenue Cycle Operations.The severity of acute cholecystitis was graded according to the Tokyo Guidelines.TG18 categorizes acute cholecystitis by Grades 1,2,and 3 representing mild,moderate,and severe,respectively.Comparisons were analyzed withχ2,Fisher’s exact test,ANOVA,ttests,and logistic regression;significance was set at P<0.05.RESULTS Four hundred eighty-six(87.7%)underwent a SA while 68 patients(12.3%)received Delayed cholecystectomy.Complication rates were increased after SA compared to Delayed cholecystectomy(18.5%vs 4.4%,P=0.004).The complication rates of patients undergoing delayed cholecystectomy was similar to the rate for elective cholecystectomy(7.4%,P=0.35).Mortality rates were 0.6%vs 0%for SA vs Delayed.Patients with moderate disease(Tokyo 2)suffered more complications among SA while none who were delayed experienced a complication(16.1%vs 0.0%,P<0.001).Total hospital charges for SA cholecystectomy were increased compared to a Delayed approach($44500±$59000 vs$35300±$16700,P=0.019).The relative risk of developing a complication was 4.2x[95%confidence interval(CI):1.4-12.9]in the SA vs Delayed groups.Among eight patients(95%CI:5.0-12.3)with acute cholecystitis undergoing SA cholecystectomy,one patient will suffer a complication.CONCLUSION Patients with Tokyo Grade 2 acute cholecystitis had more complications and increased hospital charges when undergoing SA cholecystectomy.This data supports a selective approach to SA cholecystectomy for acute cholecystitis. | Christopher P Rice Krishnamurthy B Vaishnavi Celia Chao Daniel Jupiter August B Schaeffer Whitney R Jenson Lance W Griffin William J Mileski | 2019 | World Journal of Gastroenterology2019，25，48： | 8 |
| 2 | ASPEN clinical guidelines: nutrition support therapy during adult anticancer treatment and in hematopoietic cell trans- plantation显示文摘 | August D A H uhmann M B the American Society for Paren- teral and Enteral Nutrition (ASPEN) Board of Directors | 2009 | J Parenteral Enteral Nutr2009，33，47： | 1 |
| 3 | Long-term consequences of topsoil mining on select biological and physical characteristics of two New Zealand loessial soils under grazed pasture显示文摘 | HART P B S AUGUST J A WEST A W | 1989 | Land Degrnd Rehab1989，1，1： | 1 |
| 4 | Expression of CD44 in human lung tumors显示文摘 | Penno M B August J T Baylin S B | 1994 | CancerRes1994，54，5： | 1 |
| 5 | Long-term consequences of topsoil mining on select biological and physical characteristics of two New Zealand loessial soils under grazed pasture显示文摘 | HART P B S AUGUST J A WEST A W | 1989 | Land DegradRehab1989，1，： | 1 |
| 6 | The Right Service Strategies for Product Companies 显示文摘 | Auguste B Harmon E Pandit V | 2006 | The McKinsey Quarterly2006，，1： | 1 |
| 7 | , IRE1 signaling is essential for ischemia-induced vascular en dothelial growth factor-A expression and contributes to angiogenesis and tumor growth in vivo显示文摘 | DROGAT B AUGUSTE P NGUYEN D T | 2007 | Cancer Res2007，67，14： | 1 |
| 8 | Simultaneous determination of ' earthy-musty' odorous haloanisoles and their corresponding halophenols in water samples using solid-phase microextraction coupled to gas chromatography with electron-capture detection显示文摘 | Laure M Jose D Auguste B | 2003 | J Chromatogr A2003，999，： | 1 |
| 9 | The Birmingham Hip Resurfacing:5-year clinical and radiographic results from a District General Hospital显示文摘 | Ollivere B Duckett S August A | | 0，，： | 1 |
| 10 | The Right Service Strategies for Product Companies显示文摘 | AUGUSTE B G HARMAN E P PANDIT V | 2006 | The Mckinsey Quarterly2006，，1： | 1 |
| 11 | Apoptosisof inner hair cells caused by laser ablationof their spiralganglion neurons in cultures of themouse organ of Corti显示文摘 | Sobkowicz H M Slapnick S M August B K | 1999 | J Neurocytol1999，28，1011： | 1 |
| 12 | Selenium in Biology: Facts and Medical Perspectives显示文摘 | Josef K?hrle Regina Brigelius-Flohé August B?ck Roland G?rtner Ortwin Meyer Leopold Flohé | 2000 | Biological Chemistry (-)2000，，9： | 1 |
| 13 | Water temperature and upstream migration of glass eels in New Zealand:implications of climate change显示文摘 | August S M Hicks B J | 2007 | Environmental Biology of Fishes2007，81，2： | 1 |
| 14 | Air stripping of ammonia from pig slurry:characterisation and feasibility as a pre-or post-treatment to mesophilic anaerobic digestion显示文摘 | August B Xavier F | 2003 | Waste Management2003，23，： | 1 |
| 15 | The dissociation of fluoroaluminates in FLiNaK and CsF-KF molten mixtures: A Raman spectroscopic and solubility study显示文摘 | AUGUSTE F TKATCHEVA O MEDIAAS H ΦSTVOLD T GILBERT B | 2003 | Inorganic Chemistry2003，42，20： | 1 |
| 16 | A phase Ⅱ study of pemetrexed and carboplatin in patients with locally advanced or metastatic breast cancer显示文摘 | August G Alexey M Mikhail B | 2008 | Breast Cancer Res Treat2008，110，2： | 1 |
| 17 | Water temperature and upstream migration of glass eels in New Zealand: implications of climate change 显示文摘 | August S M Hicks B J | 2007 | Environmental Biology of Fishes2007，81，2： | 1 |
| 18 | Long-term consequences of topsoil mining on select biological and physical characteristics of tow New Zealand loessial soils under grazed pasture 显示文摘 | HART P B S AUGUST J A WEST A W | 1989 | Land Degrad Rehab1989，1，： | 1 |
| 19 | 显示文摘 | CHANTAL B C JEANNETTE D G AUGUSTE F | 2008 | lnorg Chim Acta2008，361，： | 1 |
| 20 | Water temperature and upstream migration of glass eels in New Zealand:implications of climate change显示文摘 | August S M Hicks B J | 2007 | Environmental Biology of Fishes2007，81，2： | 1 |
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