Optimizing treatment for nursing home residents with acute cholecystitis

描述(申请人提供)：急性胆囊炎--胆囊炎感染--是美国最常见的胃肠道疾病之一。切除胆囊术是治疗急性胆囊炎的唯一有效方法。超过一个 三分之一的急性胆囊炎患者没有接受手术，在最初诊断的两年内会出现胆结石相关的并发症。出于这个原因，在最初发病时的胆囊切除术被认为是护理的标准。在预期寿命有限的患者中，手术的风险是否低于复发疾病的负担尚不清楚。外科手术 养老院老年居民的决策是具有挑战性的。我们的主要研究目标是通过向疗养院居民及其医疗保健提供者提供关于常见外科疾病治疗的风险和好处的真实信息，来改善对疗养院居民的护理。对于一些通常需要手术治疗的疾病，手术护理的风险 家庭居民可能会超过未来疾病并发症的负担，这些并发症在他们的有生之年可能永远不会发生。非手术治疗，如经皮胆囊液引流或单纯抗生素治疗可能更合适。这项拟议研究的目的是更好地了解手术和非手术治疗在养老院老年居民中治疗急性胆囊炎的使用和结果。为了让疗养院居民和他们的医疗保健提供者了解不同治疗策略的风险和益处，我们的项目有三个具体目标：(1)评估疗养院居民目前对急性胆囊炎的治疗，确定与使用胆囊切除和非手术治疗相关的居民和提供者的特征；2)确定决定急性胆囊炎手术和非手术治疗的短期结果的决定因素，比较接受手术和非手术治疗的居民的结果；以及3)确定居民和提供者的特征与急性胆囊炎初始治疗后纵向功能结果、存活率和复发胆囊病的关联，并比较接受手术和非手术治疗的居民的纵向结果。这种方法是创新的，因为除了共病，我们还将评估认知和功能状况-预期寿命的重要和强大预测因素-对美国65岁及以上的整个疗养院人口的急性胆囊炎治疗选择和结果的影响。这项研究意义重大，因为目前还没有关于这种常见疾病在这一庞大而脆弱的人群中的治疗和结果的信息。对于预期寿命有限的个人来说，确定减轻痛苦和最好地维持功能的个体化治疗至关重要。更好地了解疗养院居民分组中替代治疗策略的安全性和有效性，将把这种常见疾病治疗不足和治疗过度的危害降至最低。

DESCRIPTION (provided by applicant): 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 harm of both under-treatment and overtreatment of this common disease.