Utilization and Outcomes of Cholecystostomy and Cholecystectomy in Patients Admitted With Acute Cholecystitis: A Nationwide Analysis
Utilization and Outcomes of Cholecystostomy and Cholecystectomy in Patients Admitted With Acute Cholecystitis: A Nationwide Analysis
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DOI：
10.2214/ajr.20.23156
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发表时间：
2021-06-01
影响因子：
5
通讯作者：
Charalel, Resmi A.
中科院分区：
文献类型：
--
作者：
Wadhwa, Vibhor;Trivedi, Premal S.;Charalel, Resmi A.
OBJECTIVE.本研究的目的是报告急性胆囊炎住院患者经皮胆囊造口术、胆囊切除术或不干预后的国家利用趋势和结局。查询了2005年至2014年的全国住院患者样本。根据国际疾病分类第9版代码，确定住院患者并将其分为经皮胆囊造口术、胆囊切除术和无干预治疗组。结果，包括住院时间，住院死亡率，并发症，包括出血和胆汁性腹膜炎，进行了鉴定。在校正基线合并症和死亡风险后，进行多变量分析以确定治疗类型的死亡风险。在研究期间因急性胆囊炎入院的2，550，013例患者（58.6%女性，41.4%男性;平均年龄55.9岁）中，73，841例（2.9%）患者接受了经皮胆囊造口术，2，005，728例（78.7%）患者接受了胆囊切除术，459，585例（18.0%）患者未接受任何手术。经皮胆囊造口术的使用从2005年的2985例增加到2014年的12,650例。经皮胆囊造口术队列的平均年龄较高，（70.6岁）比其他两组（胆囊切除术，53.8年;无干预，62.5年），平均合并症指数较高（胆囊造口术，3.74;胆囊切除术，1.77;无干预，2.65），以及较高的平均死亡风险指数（胆囊造口术，2.88;胆囊切除术，1.45;无干预，2.07）（p
OBJECTIVE. The purpose of this study was to report national utilization trends and outcomes after percutaneous cholecystostomy, cholecystectomy, or no intervention among patients admitted to hospitals with acute cholecystitis.MATERIALS AND METHODS. The Nationwide Inpatient Sample was queried from 2005 to 2014. Admissions were identified and stratified into treatment groups of percutaneous cholecystostomy, cholecystectomy, and no intervention on the basis of International Classification of Diseases, 9th revision, codes. Outcomes, including length of stay, inpatient mortality, and complications including hemorrhage and bile peritonitis, were identified. Multivariate analysis was performed to identify mortality risk by treatment type after adjustment for baseline comorbidities and risk of mortality.RESULTS. Among 2,550,013 patients (58.6% women, 41.4% men; mean age, 55.9 years) admitted for acute cholecystitis over the study duration, 73,841 (2.9%) patients underwent percutaneous cholecystostomy, 2,005,728 (78.7%) underwent cholecystectomy, and 459,585 (18.0%) did not undergo either procedure. Use of percutaneous cholecystostomy increased from 2985 procedures in 2005 to 12,650 in 2014. The percutaneous cholecystostomy cohort had a higher mean age (70.6 years) than the other two groups (cholecystectomy, 53.8 years; no intervention, 62.5 years), a higher mean comorbidity index (cholecystostomy, 3.74; cholecystectomy, 1.77; no intervention, 2.65), and a higher mean risk of mortality index (cholecystostomy, 2.88; cholecystectomy, 1.45; no intervention, 2.07) ( p