Improving the outcome of acute cholecystitis: the non-standardized treatment must no longer be employed
Improving the outcome of acute cholecystitis: the non-standardized treatment must no longer be employed
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DOI：
10.1007/s00423-014-1245-z
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发表时间：
2014-12-01
影响因子：
2.3
通讯作者：
Munoz-Bellvis, Luis
中科院分区：
文献类型：
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作者：
Ignacio Gonzalez-Munoz, Juan;Angoso, Maria;Munoz-Bellvis, Luis
急性胆囊炎的治疗建议没有得到始终如一的执行，这导致了更高的患者发病率和更高的医疗费用。本文的目的是评估急性胆囊炎的负担，检测潜在的可修改变量，并提出治疗策略，使我们能够提高护理质量。我们对2010年1月至2012年12月入院的患者进行了回顾研究，采用单因素分析，包括入院科室、年龄、接受的治疗和住院时间。共有967名急性胆囊炎患者入院，692名(72%)入院，257名(26%)内科-消化科，18名(2%)其他科室。急诊手术498例(51.5%)，早期(确诊96小时)111例(22%)，晚期(确诊96小时)152例(30%)，延迟(其他入院)128例(26%)。进入外科的患者接受手术的可能性是进入其他科室的患者的五倍(p<；0.01)。晚期手术患者的住院时间明显长于早期手术患者(p<；0.05)和未手术患者(p<；0.05)。74岁以上的患者接受手术的频率高于老年患者(p<；0.05)。急性胆囊炎的非标准化治疗导致临床和手术变异性高、平均住院时间长、再入院次数多、住院费用高。因此，被诊断为急性胆囊炎的患者应该被送往外科，从而增加接受明确治疗的可能性。
Therapeutic recommendations of acute cholecystitis are not consistently implemented, which generates greater patient morbidity and higher health care costs. The aim of this article is to evaluate the burden of acute cholecystitis, to detect potentially modifiable variables, and to propose a therapeutic strategy that will allow us to improve the quality of care.We carried out a retrospective study of patients who were admitted to the hospital from January 2010 to December 2012 using a univariate analysis of parameters including the admitting department, age, treatment administered, and length of stay.A total of 967 patients were admitted to the hospital with a diagnosis of acute cholecystitis, 692 (72 %) to the Surgery Department, 257 (26 %) to Internal Medicine-Digestive, and 18 (2 %) to other departments. Four hundred ninety-eight (51.5 %) were operated on: 107 (21 %) on an urgent basis, 111 (22 %) at an early stage (< 96 h at diagnosis), 152 (30 %) at a late stage (> 96 h at diagnosis), and 128 (26 %) at a delayed date (other admission). Patients who were admitted into the surgery department were five times more likely to be operated on than patients admitted into other departments (p < 0.01). Patients operated on at a late stage had a longer length of stay than early stage surgery patients (p < 0.05) and than non-operated ones (p < 0.05). Patients < 74 years old were more frequently operated than older ones (p < 0.05).The non-standardized treatment of acute cholecystitis causes high clinical and surgical variability, long average stay, more readmissions, and high hospital costs. Therefore, patients with a diagnosis of acute cholecystitis should be admitted to the Surgery Department, thereby increasing the probability of receiving definite treatment.