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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 | Cloning the soil metagenome:A strategy for accessing the genetic and functional diversity of uncultured microorganisms显示文摘 | RONDON M R AUGUST P R BETTERMANN A D | 2000 | Appl Environ Microbiol2000，66，6： | 1 |
| 3 | Magnetic resonance neurogra- phy for the evaluation of peripheral nerve, braehial plexus, and nerve root disorders显示文摘 | Du R Auguste KI Chin CT | 2010 | I Neurosurg2010，112，2： | 1 |
| 4 | Clinical perspective of human colorectal cancer metastasis显示文摘 | August D A Ottow R T Sugarbaker P H | | 0，，04： | 1 |
| 5 | Hyperspectral Earth Observation From IASI 显示文摘 | Hilton F Armante R August T | 2012 | B Am Meteorol Soc2012，93，1： | 1 |
| 6 | Cloning the soil metagenome:a strategy for accessing the genetic and functional diversity of uncultured microorganisms显示文摘 | Rondon M R August P R Bettermann A D | 2000 | Appl Enviro Microbiol2000，66，6： | 1 |
| 7 | Adenovirus-related hemophagocytic syndrome after bone marrow transplantation 显示文摘 | Levy J Wodell R A August C S | 1990 | Bone Marrow Transplant1990，6，5： | 1 |
| 8 | Meta-analysis of randomised con- trolled trials on daily sedation interruption for critically ill adult patients显示文摘 | Augustes R Ho K M | 2011 | Anaesth Intensive Care2011，39，3： | 1 |
| 9 | Cloning the soil metagenome: a strategy for accessing the genetic and functional diversity of uncultured microorganisms 显示文摘 | Rondon M R August P R Bettermann A D | 2000 | Appl Environ Microbiol2000，66，6： | 1 |
| 10 | Cloning the soil metagenome : a strategy for accessing the genetic and functional diversity of uncultured microorganisms 显示文摘 | Rondon M R August P R Bettermann A D | 2000 | Appl Environ Microbiol2000，66，6： | 1 |
| 11 | Structural and aerodynamic anal- ysis of a large-scale advanced propeller blade显示文摘 | Yamamoto O August R | 1992 | Journal of Propulsion and Power1992，8，2： | 1 |
| 12 | Cloning the soil metagenome: a strategy for accessing the genetic and functional diversity of uncultured microorganisms显示文摘 | Rondon M R August P R Bettermann A D | 2000 | Am Soc Microbiol2000，66，： | 1 |
| 13 | Cloning the soil metagenome: a strategy for accessing the genetic and functional diversity of uncultured microorganisms 显示文摘 | Rondon M R August P R Bettermann A D | 2000 | Appl Environ Microbiol2000，66，： | 1 |
| 14 | Magnetic resonance neurography for the evaluation of peripheral nerve,brachial plexus,and nerve root disorders显示文摘 | Du R Auguste K I Chin C T | | 0，，02： | 1 |
| 15 | Torsional vibration and dynamic loads in a basic planetary gear system 显示文摘 | AUGUST R KASUBA R | 1986 | Journal of vibration Acoustics Stress and Reliability in Design1986，108，7： | 1 |
| 16 | Effects of a school-based cognitive-behavioral intervention for ADHD children显示文摘 | Bloomquist ML August GJ Ostrander R | 1991 | Journal of Abnormal Child psychology1991，19，5： | 1 |
| 17 | Torsional Vibrations and Dynamic Loads in a Basic Planetary Gear System显示文摘 | August R Kasuba R | | 0，，03： | 1 |
| 18 | Diffusion-weighted imaging of patients with subacute cerebral ischemia;Comparision with conventional and contrast-enhanced MR imaging显示文摘 | Augustion M Bammer R Simbrunner J | 2000 | Am J Neuroradial2000，21，9： | 1 |
| 19 | Cloning and analysis of a locus (mcr) involved in mitomycin C resistance in Streptomyces lavendulae 显示文摘 | Flickinger M C Sherman D H | 1994 | J Bacteriol1994，176，14： | 1 |
| 20 | Cloning the soil metagenome:a strategy for accessing the genetic and functional diversity of uncultured microorganisms显示文摘 | Rondon M R August P R Bettermann A D | 2000 | Applied and Environmental Microbiology2000，66，6： | 1 |
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