Optimizing treatment for nursing home residents with acute cholecystitis

急性胆囊炎-胆囊感染-是最常见的疾病之一， 胃肠道疾病在美国。切除胆囊（胆囊切除术）是唯一的 急性胆囊炎的确切治疗。超过三分之一的急性胆囊炎患者没有 接受手术的患者将在初次诊断后2年内出现胆结石相关并发症。为此 因此，在首次发作时进行胆囊切除术被认为是标准治疗。的风险是否 手术的负担是否低于复发性疾病患者的预期寿命尚不清楚。 老年疗养院居民的手术决策具有挑战性。我们的首要研究目标 是通过为疗养院居民及其医疗保健提供者提供现实的 关于常见外科疾病治疗的风险和益处的信息。对于某些条件， 通常手术治疗，手术的风险，养老院居民可能超过未来的负担， 这些疾病在他们的余生中可能永远不会发生。[非手术]治疗，如 经皮胆囊引流或单独抗生素治疗可能更合适。的目的 拟议的研究是为了更好地了解手术和[非手术]治疗的使用和结果， 养老院老年人急性胆囊炎的调查分析告知疗养院的居民和他们的医疗保健 我们的项目有三个具体目标：[1] 评估目前护理之家居民急性胆囊炎的治疗方法， 与使用胆囊切除术和[非手术]治疗相关的提供者特征，2）识别 护理之家居民手术和[非手术]治疗后短期结果的决定因素 急性胆囊炎，并比较接受手术与非手术治疗的居民的结果 以及3）确定居民和提供者特征与纵向功能之间的关联 急性胆囊炎初始治疗后的结局、生存率和复发性胆囊疾病， 接受手术和非手术治疗的居民的纵向结果。方法是创新的 因为，除了合并症，我们还将评估认知和功能状态的影响-重要的是 和预期寿命的强有力的预测因素--关于急性胆囊炎的治疗选择和结局 美国65岁及以上的养老院人口。这项研究意义重大，因为 目前还没有关于这种常见疾病的治疗和结果的信息， 弱势群体。对于预期寿命有限的个人，确定个性化治疗， 减轻痛苦和最好地保持功能是必不可少的。更好地了解安全性和有效性 在养老院居民的亚组中采用替代治疗策略将最大限度地减少两者的危害 这种常见疾病的治疗不足和过度。

Project Summary/Abstract Acute cholecystitis - infection of the gallbladder - is one of the most common gastrointestinal conditions in the United States. Removal of the gallbladder (cholecystectomy) is the only definitive treatment for acute cholecystitis. More than a third of patients with acute cholecystitis who do not undergo surgery will experience gallstone related complications within 2 years of initial diagnosis. For this reason, cholecystectomy at the time of initial episode is considered the standard of care. Whether the risks of surgery are lower than the burdens of recurrent disease in patients with limited life-expectancy is unclear. Surgical decision-making for elder nursing home residents is challenging. Our overarching research objective is to improve care for nursing home residents by providing them and their health care providers realistic information about risks and benefits of treatment for common surgical diseases. For some conditions that are usually treated surgically, the risks of surgery for nursing home residents may outweigh the burdens of future disease complications that may never occur during their remaining lifetime. [Nonsurgical] therapies such as percutaneous gallbladder drainage or antibiotic therapy alone may be more appropriate. The objective of the proposed study is to better understand the use and outcomes of surgery and [nonsurgical] therapy to treat acute cholecystitis in elder nursing home residents. To inform nursing home residents and their health care providers about risks and benefits of different treatment strategies our project has three specific aims: [1) To evaluate current treatments for acute cholecystitis among nursing home residents and determine resident and provider characteristics associated with the use of cholecystectomy and [nonsurgical] treatment, 2) to identify determinants of short term outcomes after surgery and [nonsurgical] treatment among nursing home residents with acute cholecystitis and compare the outcomes of residents undergoing surgical v nonsurgical treatment and 3) to determine the association between resident and provider characteristics and longitudinal functional outcomes, survival, and recurrent gallbladder disease after initial treatment for acute cholecystitis and compare longitudinal outcomes of residents undergoing surgical and nonsurgical treatment.] The approach is innovative because, in addition to comorbidity, we will evaluate the impact of cognitive and functional status - important and powerful predictors of life expectancy - on treatment choice and outcomes for acute cholecystitis in the entire nursing home population age 65 and older in the United States. This study is significant because currently there is no information about treatment and outcomes for this common disease in this large and vulnerable population. For individuals with limited life expectancy, determining the individualized treatment that alleviates suffering and best maintain function is essential. Better knowledge of the safety and effectiveness of alternative treatment strategies in subgroups of nursing home residents will minimize the harms of both undertreatment and overtreatment of this common disease.