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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 | First evidence supporting a potential role for the BMP/SMAD pathway in the progression of oestrogen receptor-positive breast cancer显示文摘 | Helms MW Packeisen J August C | 2005 | J Pathol2005，206，3： | 1 |
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| 14 | Acute deep vein thrombosis and endovaseular techniques: It is time for a new aggiornamento! 显示文摘 | Pemfis J M Auguste M Kovarski S | 2012 | Diagnostic and interventional imaging2012，93，10： | 1 |
| 15 | Dedifferentiation of odontogenic keratocyst epithelium after cyst decompression 显示文摘 | August M Faquin WC Troulis M J | 2003 | J Oral Maxillofac Surg2003，61，6： | 1 |
| 16 | Neurosensory deficit and functional impairment after sagittal ramus osteotomy:a long-term follow-up study 显示文摘 | August M Marchena J Donady J | 1998 | J Oral Maxillofac Surg1998，56，11： | 1 |
| 17 | The Microbial formation of the 23-Keto derivative from avermectin B2a in soil显示文摘 | Vincent P G August J K John G M | 1983 | Pestic Sci1983，，14： | 1 |
| 18 | Vagus nerve stimulation for epilepsy: a meta-analysis of efficacy and predictors of response 显示文摘 | Englot D J Chang EF Auguste KI | 2011 | J Neurosurg2011，115，6： | 1 |
| 19 | 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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