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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 | A randomized trial of therapies for type 2 diabetes and coronary artery disease显示文摘 | BARI 2D Study Group Frye RL August P | | New England Journal of Medicine0，，： | 1 |
| 4 | The role of fibroblast growth factors in vascular development显示文摘 | Javerzat S Auguste P Bikfalvi A | 2002 | Trends Mol Med2002，8，10： | 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 Degrnd Rehab1989，1，1： | 1 |
| 6 | Clinical perspective of human colorectal cancer metastasis显示文摘 | August D A Ottow R T Sugarbaker P H | | 0，，04： | 1 |
| 7 | 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 |
| 8 | Bloc- king fibroblast growth factor receptor signaling inhibits tumor growth, lymphangiogenesis, and metastasis 显示文摘 | Larrieu-Lahargue F Welm A Auguste P | 2012 | Plos One2012，7，39： | 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 Enviro Microbiol2000，66，6： | 1 |
| 10 | Molecular mechanisms of tumor vascularization显示文摘 | Auguste P Lemiere S Larrieu-Lahargue F | 2005 | Crit Rev Oncol Hematol2005，54，1： | 1 |
| 11 | Transforming growth fac- tor beta and progression of renal disease显示文摘 | AUGUST P SUTHANTHIRAN M | 2003 | Kid Inter2003，11，87： | 1 |
| 12 | The T as- sessment tool:a simple metric for assessing multidisciplinary graduate education 显示文摘 | AUGUST P V SwIFr J M KELLOGG D Q | 2010 | Journal of Natural Resources & Life Sciences Education2010，，39： | 1 |
| 13 | Management of renal disease in pregnancy显示文摘 | Podymow T August P Akbari A | | 0，，02： | 1 |
| 14 | 显示文摘 | Guillet C Auguste P Mayo W | 1999 | Neuroscience1999，19，4： | 1 |
| 15 | Effects of spatial extent on landscape structure and sedimentmetal concentration relationships in small estuarine systems of the United States' Mid - Atlantic Coast 显示文摘 | Hollister J W August P V Paul J F | 2008 | Landscape Ecology2008，23，： | 1 |
| 16 | Factors influencing the longterm outcome of mandibular reconstruction 显示文摘 | August M Tompach P Chang Y | 2000 | Oral Maxilofac Surg2000，58，6： | 1 |
| 17 | Invasive approaches to treatment of venous thromboembolism 显示文摘 | Augustions P Ouriel K | 2004 | Circulation2004，110，9： | 1 |
| 18 | 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 |
| 19 | 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 |
| 20 | , 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 |
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