Resource use for cholecystectomy with versus without cholangiography: A multicenter, propensity-matched analysis.
Resource use for cholecystectomy with versus without cholangiography: A multicenter, propensity-matched analysis.
复制标题
有胆管造影与无胆管造影的胆囊切除术的资源使用：多中心、倾向匹配分析。
DOI：
10.1016/j.surg.2023.04.027
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发表时间：
2023
期刊：
影响因子：
3.8
通讯作者：
Loftus,TylerJ
中科院分区：
文献类型：
--
作者：
Filiberto,AmandaC;Nyren,MollyQ;Underwood,PatrickW;Balch,JeremyA;Abbott,KennethL;Efron,PhilipA;SarosiJr,GeorgeA;Bihorac,Azra;UpchurchJr,GilbertR;Loftus,TylerJ
背景术中胆道造影术可早期发现胆总管损伤和胆总管结石。术中胆道造影术在减少与胆道病理相关的资源使用方面的作用尚不清楚。这项研究验证了零假设，即接受与不接受术中胆道造影术的腹腔镜胆囊切除术患者在资源利用方面没有差异。方法采用回顾性纵向队列研究方法，对3所大学医院3151例接受腹腔镜胆囊切除术的患者进行研究。为了在保持足够的统计能力的同时最大限度地减少基线特征的差异，倾向评分被用来匹配830名在外科医生的判断下接受术中胆道造影术的患者和795名在没有术中胆道造影术的情况下接受胆囊切除术的患者。主要结果是术后内窥镜逆行胆道造影术的发生率、手术和内窥镜逆行胆道造影术之间的间隔以及总的直接成本。结果在倾向匹配分析中，术中胆道造影组和无术中胆道造影组的年龄、合并症、美国麻醉医师协会序贯器官衰竭评估评分和总胆红素/直接胆红素比率相似。术中胆道造影组术后内窥镜逆行胆道造影率较低(2.4%比4.3%；P=0.05)。04)，胆囊切除和内窥镜逆行胆道造影术之间的间隔较短(2.5[1.0-17.8]天vs4.5[2.0-9.5]天；P=。和较短的住院时间(0.3[0.2-1.5]天比1.4[0.3-3.2]天；P<；001)。术中胆道造影术患者的总直接成本较低(4.0K[3.6K-5.4K]vs 8.1K[4.9K-13.0K]；P<；001)。在队列中，30天或一年的死亡率没有差异。结论与未行术中胆道造影术的腹腔镜胆囊切除术相比，术中胆道造影术减少了手术资源的消耗，其主要原因是术后逆行胆道造影术的发生率较低，时间较早。
Background Intraoperative cholangiography may allow for earlier identification of common bile duct injury and choledocholithiasis. The role of intraoperative cholangiography in decreasing resource use related to biliary pathology remains unclear. This study tests the null hypothesis that there is no difference in resource use for patients undergoing laparoscopic cholecystectomy with versus without intraoperative cholangiography. Methods This retrospective, longitudinal cohort study included 3,151 patients who underwent laparoscopic cholecystectomy at 3 university hospitals. To minimize differences in baseline characteristics while maintaining adequate statistical power, propensity scores were used to match 830 patients who underwent intraoperative cholangiography at surgeon discretion and 795 patients who underwent cholecystectomy without intraoperative cholangiography. Primary outcomes were the incidence of postoperative endoscopic retrograde cholangiography, the interval between surgery and endoscopic retrograde cholangiography, and total direct costs. Results In the propensity-matched analysis, the intraoperative cholangiography and no intraoperative cholangiography cohorts had similar age, comorbidities, American Society of Anesthesiologists Sequential Organ Failure Assessment scores, and total/direct bilirubin ratios. The intraoperative cholangiography cohort had a lower postoperative endoscopic retrograde cholangiography (2.4% vs 4.3%; P=. 04), a shorter interval between cholecystectomy and endoscopic retrograde cholangiography (2.5 [1.0–17.8] vs 4.5 [2.0–9.5] days; P=. 04), and shorter length of stay (0.3 [0.2–1.5] vs 1.4 [0.3–3.2] days; P<. 001). Patients undergoing intraoperative cholangiography had lower total direct costs ($4.0 K [3.6 K–5.4 K] vs $8.1 K [4.9 K–13.0 K]; P<. 001). There were no differences in 30-day or 1-year mortality among the cohorts. Conclusion Compared with laparoscopic cholecystectomy without intraoperative cholangiography, cholecystectomy with intraoperative cholangiography was associated with decreased resource use, which was primarily attributable to decreased incidence and the earlier timing of postoperative endoscopic retrograde cholangiography.