Finding the Most Favorable Timing for Cholecystectomy after Percutaneous Cholecystostomy Tube Placement: An Analysis of Institutional and National Data
Finding the Most Favorable Timing for Cholecystectomy after Percutaneous Cholecystostomy Tube Placement: An Analysis of Institutional and National Data
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DOI：
10.1016/j.jamcollsurg.2020.10.010
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发表时间：
2021-01-01
影响因子：
5.2
通讯作者：
Palazzo, Francesco
中科院分区：
文献类型：
--
作者：
Woodward, Steven G.;Rios-Diaz, Arturo J.;Palazzo, Francesco
背景技术背景：早期胆囊切除术（E-CCY; 8周或更短时间）与术后并发症增加相关，但这一发现尚未在国家层面得到验证，也未对经皮胆囊造口术管（PCT）相关并发症和干预措施（PCT-RCI）进行评估。研究设计：在全国再入院数据库（2010-2015）中确定了因急性胆囊炎而接受CCY的成人PCT患者和我们的机构（2017-2019）。在全国范围内，使用Poisson回归比较E-CCY与延迟胆囊切除术（D-CCY;超过8周），估计术后并发症的校正相对风险（aRR）。采用卡方检验和Kruskal-Wallis检验比较E-CCY和D-CCY之间的机构PCT-RCI、手术数据和术后结局。结果：在全国再入院数据库的6,145例患者中，32.9%为D-CCY。风险调整分析发现E-CCY和D-CCY在并发症（aRR 0.98; 95% CI，0.89 - 1.07）、死亡率（aRR 0.88; 95% CI，0.43 - 1.81）或30天再入院率（aRR 1.04; 95% CI，0.85 - 1.27）方面无差异。评估间隔胆囊切除术（IC）时间与发病率相关性的风险调整分析表明，PCT置入后第一个月内手术并发症风险增加（aRR 1.17; 95% CI，1.08 - 1.33）。在机构队列（E-CCY，n = 23; D-CCY，n = 45）中，在估计失血量、住院时间和术后并发症方面没有发现统计学显著差异。根据我们的未调整分析，D-CCY组的PCT-RCI增加（26. 9% E-CCY vs 69% D-CCY; p < 0.01）。结论：在PCT放置后1个月内进行IC时，手术并发症增加，在PCT放置后8周进行IC时，PCT-RCI增加，这表明IC的最佳时机是PCT放置后4 - 8周。(C)2020年美国外科医生学会爱思唯尔公司出版版权所有© 2016
BACKGROUND: Early cholecystectomy (E-CCY; 8 weeks or less) after percutaneous cholecystostomy tube (PCT) placement has been associated with increased postoperative complications, but this finding has not been validated at a national level and PCT-related complications and interventions (PCT-RCIs) were not evaluated.STUDY DESIGN: Adults with PCT for acute cholecystitis subsequently undergoing CCY were identified within the Nationwide Readmission Database (2010-2015) and our institution (2017-2019). Adjusted relative risks (aRRs) of postoperative complications were estimated using Poisson regression comparing E-CCY with delayed cholecystectomy (D-CCY; more than 8 weeks) within the nationwide cohort. Institutional PCT-RCIs, operative data, and postoperative outcomes were compared between E-CCY and D-CCY using chi-square and Kruskal-Wallis tests.RESULTS: Of 6,145 patients from the Nationwide Readmission Database, 32.9% were D-CCY. Riskadjusted analysis identified no differences between E-CCY and D-CCY in complications (aRR 0.98; 95% CI, 0.89 to 1.07), mortality (aRR 0.88; 95% CI, 0.43 to 1.81), or 30-day readmissions (aRR 1.04; 95% CI, 0.85 to 1.27). Risk-adjusted analyses assessing the association of time to interval cholecystectomy (IC) with morbidity indicated an increased risk of surgical complications in the first month after PCT placement (aRR 1.17; 95% CI, 1.08 to 1.33). In the institutional cohort (E-CCY, n = 23; D-CCY, n = 45), there were no statistically significant differences found in estimated blood loss, length of stay, and postoperative complications. There were increased PCT-RCIs in the D-CCY group (26.9% E-CCY vs 69% D-CCY; p < 0.01) based on our unadjusted analysis.CONCLUSIONS: Increased operative complications when IC is performed within 1 month of PCT placement and increased PCT-RCIs when IC is performed 8 weeks after PCT placement suggest that the most favorable timing for IC is between 4 and 8 weeks after PCT placement. (C) 2020 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.)