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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 | Studies on inverter-fed five-phase induction motor drive 显示文摘 | Pavithran K N Parimelalagan R Krishnamurthy M R | 1988 | IEEE Power Elec1988，3，2： | 2 |
| 3 | Bubbles and capital flow volatility: Causes and risk management 显示文摘 | Caballero R J Krishnamurthy A | 2006 | Journal of Monetary Economics2006，53，1： | 1 |
| 4 | Study on vital static properties of fine blanking of GFRP composites with that of conventional drillingl显示文摘 | BASKARAN G GOWRI S KRISHNAMURTHY R | 2010 | Int J Adv Manuf Techno2010，，50： | 1 |
| 5 | Adaptive Symbol Tracking Using Discrete Stochastic Approximation for Wireless OFDM Systems 显示文摘 | ATHAUDAGE C R N KRISHNAMURTHY V | 2004 | IEEE Communications Society2004，，： | 1 |
| 6 | Structural alterations in the workpiece by ultrasonic drilling 显示文摘 | Adithan M Krishnamurthi R | 1978 | Wear1978，44，2： | 1 |
| 7 | Malignant granular cell tumor of the tongue:a clinico-pathological challenge显示文摘 | Krishnamurthy A George R Maihi U | 2014 | Indian J Surg Oncol2014，5，1： | 1 |
| 8 | Dose-dependent food allergy induction against ovalbumin under acid-suppression: A 显示文摘 | Diesner SC Knittelfelder R Krishnamurthy D | 2008 | Immunol Lett2008，121，： | 1 |
| 9 | Development of improved method to quantify maldistribution and its effect on structured packing column performance显示文摘 | EDWARDS D P KRISHNAMURTHY K R POTFHOFF R W | 1999 | Trans IChemE1999，77，： | 1 |
| 10 | Designing leakage tolerant, low power wide-OR dominos for sub-130nm CMO6 technologies 显示文摘 | CHATTERJEE B SACHDEV M KRISHNAMURTHY R | 2005 | Microelectronics Journal2005，36，6： | 1 |
| 11 | Stable carbon isotope biogeochemistu of a shallow sand aquifer contam- inated with fuel hydrocarbons显示文摘 | Fang J S Barcelona M J Krishnamurthy R V | 2000 | Applied Geochemistry2000，15，2： | 1 |
| 12 | Avatar information extraction system 显示文摘 | Jayram T S Krishnamurthy R Raghavan S | 2006 | IEEE Data Engineering Bulletin2006，29，1： | 1 |
| 13 | Studies on inverter-fed five-phase induction motor drive显示文摘 | Pavithran K N Parimelalagan R Krishnamurthy M R | 1988 | IEEE Transactions on PowerElectronics1988，3，2： | 1 |
| 14 | Palaeoclimatic changes deduced from ^13C/^12C and C/N ratios of Karewa lake sediments,India显示文摘 | Krishnamurthy R V Bhattacharya S K Kusumgar S | 1986 | Nature1986，323，： | 1 |
| 15 | Triple negative breast cancer - our experience and review 显示文摘 | Krishnamurthy S Poornima R Challa VR | 2012 | Indian J Surg Oncol2012，3，1： | 1 |
| 16 | Extracting,linking and integrating data from public sources:a financial case study显示文摘 | Burdick D Hernández M A Ho H Koutrika G Krishnamurthy R Popa L Sranoi I Vaithyanathan S Das S R | | 0，，03： | 1 |
| 17 | Isotopic and molecular analyses of hydrocarbons and monocarboxylic acids from the Murchison meteorite显示文摘 | KRISHNAMURTHY R V EPSTEIN S CRONIN J R | 1992 | Geochimica et Cosmochimica Acta1992，56，： | 1 |
| 18 | Nanocomposites based on a combination of epoxy resin,hyperbranched epoxy and a layered silicate显示文摘 | Becker O Krishnamurthy R | 2003 | Polymer2003，44，： | 1 |
| 19 | Triple negative breast cancer - our experience and review 显示文摘 | Krishnamurthy S Poornima R Challa VR | 2012 | Indian J Surg Oncol2012，3，1： | 1 |
| 20 | Pediatric cardiac MRI: anatomy and function 显示文摘 | Krishnamurthy R | 2008 | Pediatr Radiol2008，38，2： | 1 |
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