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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 | Fabrication and Magnetic-properties of arrays of metallic nanowires显示文摘 | Whitney T M Jiang J S Searson P C | 1993 | Science1993，261，： | 2 |
| 3 | K-shell line ratio and powers for diagnosing cylindrical plasmas of neon, aluminum, argon and titanium显示文摘 | Apruzese J P Whitney K G Davis J | 1997 | Journal of Quantitative Spectroscopy and Radiation Transfer1997，57，1： | 1 |
| 4 | Invasive Pneumococcal Disease in Children 5 Years After Conjugate Vaccine Introduction - Eight States, 1998-2005显示文摘 | Reingold A Hadler J Farley M M Harrison L Lynfield R Lexau C Bennett N Thomas A Craig A S Smith P J Beall B Whitney C G Moore M Pilishvili T | 2008 | MMWR Morbidity and Mortality Weekly Report2008，，6： | 1 |
| 5 | Volumetric analysis andhydrologic characterization of a modem debris flow near Yucca Mountain Nevada 显示文摘 | Coe J A Glancy P A Whitney J W | 1997 | Geomorphology1997，，20： | 1 |
| 6 | Methane production in a 100-L upflow bioreactor by anaerobic digestion of farm waste显示文摘 | Borole Abhijeet P Klasson K Thomas Ridenour Whitney | 2006 | Applied Biochemistry and Biotechnolo~v2006，131，123： | 1 |
| 7 | Fabrication and magnetic properties of array of metallic nanowires显示文摘 | Whitney T M Jiang J S Searson P C etal | 1993 | Science1993，261，3： | 1 |
| 8 | Iron-catalyzed cross-coupling reactions between a bicyclic alkenyl triflate and Grignard reagents显示文摘 | MARQUAND P L TSUI G C WHITNEY J C C | | 0，，： | 1 |
| 9 | A modelbased method for organizing tasks in product development显示文摘 | EPPINGER S D WHITNEY D E SMITH R P | 1994 | Research in Engineering Design1994，6，1： | 1 |
| 10 | Volumetric analysis and hydrologic characterization of a modern debris flow near Yucca Mountain Nevada显示文摘 | Coe J A Glancy P A Whitney J W | 1997 | Geomorphology1997，，20： | 1 |
| 11 | Cervicogenicdizziness: a review of diagnosis and treatment显示文摘 | Wrisley D Sparto P Whitney S | 2000 | Journal of Orthopeadic and Sports Physical Therapy2000，30，12： | 1 |
| 12 | 显示文摘 | Whitney T W JiangJ S Searson P C | 1993 | Science1993，261，： | 1 |
| 13 | A modelbased method for organizing tasks in product development显示文摘 | Eppinger S D Whitney D E Smith R P | 1994 | Research in Engineering Design1994，，6： | 1 |
| 14 | A Model based Method for Organizing Tasks in Product Development显示文摘 | Eppinger S D Whitney I) E Smith R P | 1994 | Research in Engineering Design1994，，6： | 1 |
| 15 | Mass spectrometry of selected components of biologibal interest in green tea extracts显示文摘 | Miketobva P Schram KH Whitney JL | | 0，，： | 1 |
| 16 | Form I Rubiscos from non-green algae are expressed abundantly but not assembled in tobacco chloroplasts 显示文摘 | Whitney S P Baldet P Hudson G S | 2001 | Plant Journal2001，26，： | 1 |
| 17 | Ascorbic acid in Drosophila and changes during aging显示文摘 | Massie H R Shumway M E Whitney S J P | 1991 | Experimental Gerontology1991，26，5： | 1 |
| 18 | ThemeRiver:visualizing thematic changes in large document collections显示文摘 | HAVRE S HETZLER E WHITNEY P | 2002 | IEEE Transactions on Visualization and Computer Graphics2002，18，1： | 1 |
| 19 | Prevention of pneumococeal disease among infants and children - use of 13 - valent pneoeeal conjugate vaccine and 23 - valent pnemmxxcal polysaceharide vaccine - ee- ommendations of the Advisory Committee on Immunization Practices (ACIP) 显示文摘 | Nuorti J P Whitney C G | 2010 | MMWR Recomm Rep2010，10，： | 1 |
| 20 | ThemeRiver: visuali- zing thematic changes in large document collections显示文摘 | HAVRE S ttETZLER E WHITNEY P | 2002 | IEEE transac- tions on visualization and computer graphics2002，8，1： | 1 |
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