An urban-rural blight? Choledocholithiasis presentation and treatment.
An urban-rural blight? Choledocholithiasis presentation and treatment.
复制标题
城乡融合？
DOI：
10.1016/j.jss.2011.05.031
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Poulose,BenjaminK
中科院分区：
文献类型：
--
作者：
Shelton,Julia;Kummerow,Kristy;Phillips,Sharon;Griffin,Marie;Holzman,MichaelD;Nealon,William;Pinson,CWright;Poulose,BenjaminK
背景：探索城乡和地区差异对于建立有效的医疗服务体系至关重要。胆总管结石（CDL）仍然是一个常见的问题，有一系列的治疗选择和潜在的严重并发症。本研究评估了UR和CDL表现和治疗的地区差异。我们假设尿路状态导致CDL治疗的差异。方法本研究调查了2007年医疗保健成本和利用项目数据集的患者。确定了CDL患者的住院出院率和干预措施。UR和区域名称根据国家卫生统计中心指南确定。合并胰腺炎或胆管炎的患者被定义为复杂CDL （cCDL）患者。CDL的干预分为内窥镜、手术或经皮治疗。复样本比例分析。结果共鉴定出CDL患者111,021例；这些患者中81%生活在城市地区，19%生活在农村地区；61%为无并发症胆总管结石（uCDL）， 39%为cCDL。uCDL和cCDL的总体分布没有因UR状态或地区而异。农村患者未接受干预的比例为45.1% （95%CI 41.8% ~ 48.4%）高于城市患者30.5% (28.8% ~ 32.2%),P < 0.05。城市患者采用内镜干预的可能性为87.7%(86.8% ~ 88.6%)，农村为82.0% (79.3% ~ 84.7%),P < 0.05。农村患者手术率为10.5%(8.6% ~ 12.4%)，城市患者为4.9% (4.4% ~ 5.4%),P < 0.05。区域差异对所接受的干预类型没有影响。结论农村患者接受CDL干预的频率较低，手术干预的比例较高，与症状严重程度无关。
BACKGROUNDExploration of urban-rural (UR) and regional differences is critical to developing effective healthcare delivery systems. Choledocholithiasis (CDL) remains a common problem with a range of therapeutic options and potentially severe complications. This study evaluated UR and regional differences of CDL presentation and treatment. We hypothesized that UR status contributes to differences in treatment of CDL.METHODSThis study examined patients from the 2007 Healthcare Cost and Utilization Project dataset. Inpatient discharges and interventions for CDL patients were identified. UR and regional designations were determined from National Center for Health Statistics guidelines. Patients with pancreatitis or cholangitis were designated as complicated CDL (cCDL) patients. Interventions for CDL were classified as endoscopic, surgical, or percutaneous. Complex-sample proportion analyses were performed.RESULTSA total of 111,021 patients with CDL were identified; 81% of these patients lived in urban areas compared with 19% in rural areas; 61% had uncomplicated choledocholithiasis (uCDL) and 39% had cCDL. The overall distribution of uCDL and cCDL did not differ by UR status or region. A higher proportion of rural patients did not receive an intervention 45.1% (95%CI 41.8%–48.4%) versus urban patients 30.5% (28.8%–32.2%), P < 0.05. Interventions for urban patients were more likely endoscopic 87.7% (86.8%–88.6%) compared with rural 82.0% (79.3%–84.7%), P < 0.05. Rural patients were more likely to undergo surgery 10.5% (8.6%–12.4%) than urban patients 4.9% (4.4%–5.4%), P < 0.05. Regional variations did not impact the type of intervention received.CONCLUSIONRural patients received CDL interventions less often and had a higher proportion of surgical interventions regardless of severity of presentation.
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作者：
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影响因子：
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