Growing use of laparoscopic cholecystectomy in the national Veterans Affairs Surgical Risk Study: effects on volume, patient selection, and selected outcomes.
Growing use of laparoscopic cholecystectomy in the national Veterans Affairs Surgical Risk Study: effects on volume, patient selection, and selected outcomes.
复制标题
在国家退伍军人事务部手术风险研究中越来越多地使用腹腔镜胆囊切除术：对手术量、患者选择和选定结果的影响。
作者：
Arnold Y. Chen;Jennifer Daley;Theodore N. Pappas;William G. Henderson;Shukri F. Khuri
目的
研究1991年10月至1993年12月参加国家退伍军人事务部手术风险研究的43个三级护理大学附属退伍军人管理局医疗中心（VAMC）引入腹腔镜胆囊切除术的情况。
背景数据摘要
先前在私营部门的研究已经证明，随着腹腔镜胆囊切除术的引入，胆囊切除术的数量增加，胆囊切除术的临床阈值下降。
方法
分析了以下指标随时间的变化：患者术前风险、手术复杂性、胆道疾病严重程度、手术次数、术后住院时间、术后30天死亡率和一般并发症发生率。
结果
腹腔镜胆囊切除术的数量增加，但胆囊切除术的总数量随时间保持稳定。急性胆囊炎、急诊胆囊切除术和技术复杂的胆囊切除术的患者比例未随时间变化或略有增加。腹腔镜胆囊切除术术后一般并发症的校正几率低于开腹胆囊切除术，但所有胆囊切除术的术后30天死亡率和一般并发症发生率随时间推移保持不变。所有胆囊切除术的术后住院时间显著下降。腹腔镜胆囊切除术的实施率在医院之间差异很大。腹腔镜胆囊切除术的采用速度更慢，并且胆囊切除术的使用比例低于非VA设置。
结论
与非VA研究显示自引入腹腔镜胆囊切除术以来总体胆囊切除术量增加相反，这些VAMC实施了腹腔镜胆囊切除术，而胆囊切除术没有增长或胆囊切除术的临床阈值发生变化。腹腔镜胆囊切除术与更好的结局相关，但在胆囊切除术量稳定和胆道疾病病例组合的情况下引入腹腔镜胆囊切除术并没有改变术后死亡率和并发症发生率。稳定的胆囊切除术量和胆道疾病病例组合，采用较慢，腹腔镜胆囊切除术的使用率较低，与以前的报告形成对比，可能是由于患者和组织的差异以及VA与非VA设置的融资。
OBJECTIVE
To study the introduction of laparoscopic cholecystectomy to the 43 tertiary-care university-affiliated Veterans Administration medical centers (VAMCs) participating in the National Veterans Affairs Surgical Risk Study from October 1991 through December 1993.
SUMMARY BACKGROUND DATA
Previous studies in the private sector have documented growth in the number of cholecystectomies and falling clinical thresholds for cholecystectomy with the introduction of laparoscopic cholecystectomy.
METHODS
The following were analyzed for changes over time: measures of patient preoperative risk, complexity of surgery, severity of biliary disease, numbers of procedures, postoperative length of stay, and 30-day postoperative mortality and general complication rates.
RESULTS
The number of cholecystectomies performed laparoscopically increased, but the total number of cholecystectomies performed remained stable over time. The proportion of patients with acute cholecystitis, emergent cholecystectomies, and technically complex cholecystectomies did not change or increased slightly over time. Adjusted odds for postoperative general complications were lower for laparoscopic than for open cholecystectomy, but 30-day postoperative mortality and general complication rates for all cholecystectomies remained constant over time. Postoperative length of stay for all cholecystectomies fell significantly. Implementation rates of laparoscopic cholecystectomy varied widely between hospitals. Laparoscopic cholecystectomy was adopted more slowly and used in a lower percentage of cholecystectomies than in non-VA settings.
CONCLUSIONS
In contrast to non-VA studies showing increases in overall cholecystectomy volume since the introduction of laparoscopic cholecystectomy, these VAMCs implemented laparoscopic cholecystectomy without growth in cholecystectomies or a change in the clinical threshold for cholecystectomy. Laparoscopic cholecystectomy was associated with better outcomes, but its introduction in the setting of stable cholecystectomy volume and biliary disease case mix did not change postoperative mortality and complication rates. The stable cholecystectomy volume and biliary disease case mix, slower adoption, and lower use of laparoscopic cholecystectomy contrast with previous reports and may result from differences in patients and organization and financing of VA versus non-VA settings.
我院采用腹腔镜胆囊切除术。
影响因子：
3
作者：
Fendrick,AM;Escarce,JJ;McLane,C;Shea,JA;Schwartz,JS
通讯作者：
Schwartz,JS