手术时间对胆囊切除术后轻度胆结石胰腺炎的结果的影响
Nam Yong Cho1, Nikhil L Chervu2, Sara Sakowitz3
1Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: https://twitter.com/NamYong_Cho.
Surgery
|June 24, 2023
概括
早期胆囊切除术 (在2天内切除胆囊) 对于轻微的胆结石胰腺炎与较少的不良事件和较低的成本有关. 推迟手术增加了风险,住院和再入院,凸显了迅速手术干预的必要性.
科学领域:
- 胃肠病学 胃肠病学
- 外科手术的结果
- 卫生经济学 卫生经济学
背景情况:
- 之前的研究表明,早期胆囊切除术可以缩短患有轻度胆结石胰腺炎的住院时间.
- 然而,这些研究缺乏评估不良事件的能力.
- 本研究使用国家队列来检查胆囊切除术时间及其对结果的影响.
研究的目的:
- 评估胆囊切除术时间与轻度胆结石胰腺炎患者的临床结果之间的关联.
- 评估早期与晚期胆囊切除术对不良事件和资源利用的影响.
- 为了向临床实践提供关于胆结石胰腺炎最佳手术时间的信息.
主要方法:
- 分析2016-2019年全国再接收数据库,用于成人住院治疗胆结石胰腺炎.
- 排除末端器官功能障碍或胆管炎的患者,以专注于轻度病例.
- 腹腔镜胆囊切除术的分类为早期 (2天内) 和晚期 (>2天) 队列.
- 多变量回归以评估时间与重大不良事件 (30天死亡率,术后并发症) 和次要结果 (停留时间,费用,出院安排,再接收) 的关联.
主要成果:
- 晚期队列 (手术>2天) 较老,更男性,更有可能接受手术前的ERCP.
- 晚期胆囊切除术与显著更高的重大不良事件发生率相关 (aOR 1.40).
- 延迟手术也使调整后的住院费用增加了2,700美元,30天再入院几率 (aOR 1.12) 和非家庭出院几率 (aOR 1.42).
结论:
- 延迟胆囊切除术超过2天,以治疗轻度胆结石胰腺炎,独立地与增加主要不良事件有关.
- 晚期手术会导致更高的住院费用,增加30天的再入院,以及更高的非家庭出院的可能性.
- 优先考虑轻度胆结石胰腺炎的早期手术干预对于改善患者的治疗结果和降低医疗保健成本至关重要.
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