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| 1 | Operative complications and economic outcomes of cholecystectomy for acute cholecystitis显示文摘BACKGROUND Recent management of acute cholecystitis favors same admission(SA)or emergent cholecystectomy based on overall shorter hospital stay and therefore cost savings.We adopted the practice of SA cholecystectomy for the treatment of acute cholecystitis at our tertiary care center and wanted to evaluate the economic benefit of this practice.We hypothesized that the existence of complications,particularly among patients with a higher degree of disease severity,during SA cholecystectomy could negate the cost savings.AIM To compare complication rates and hospital costs between SA vs delayed cholecystectomy among patients admitted emergently for acute cholecystitis.METHODS Under an IRB-approved protocol,complications and charges for were obtained for SA,later after conservative management(Delayed),or elective cholecystectomies over an 8.5-year period.Patients were identified using the acute care surgery registry and billing database.Data was retrieved via EMR,operative logs,and Revenue Cycle Operations.The severity of acute cholecystitis was graded according to the Tokyo Guidelines.TG18 categorizes acute cholecystitis by Grades 1,2,and 3 representing mild,moderate,and severe,respectively.Comparisons were analyzed withχ2,Fisher’s exact test,ANOVA,ttests,and logistic regression;significance was set at P<0.05.RESULTS Four hundred eighty-six(87.7%)underwent a SA while 68 patients(12.3%)received Delayed cholecystectomy.Complication rates were increased after SA compared to Delayed cholecystectomy(18.5%vs 4.4%,P=0.004).The complication rates of patients undergoing delayed cholecystectomy was similar to the rate for elective cholecystectomy(7.4%,P=0.35).Mortality rates were 0.6%vs 0%for SA vs Delayed.Patients with moderate disease(Tokyo 2)suffered more complications among SA while none who were delayed experienced a complication(16.1%vs 0.0%,P<0.001).Total hospital charges for SA cholecystectomy were increased compared to a Delayed approach($44500±$59000 vs$35300±$16700,P=0.019).The relative risk of developing a complication was 4.2x[95%confidence interval(CI):1.4-12.9]in the SA vs Delayed groups.Among eight patients(95%CI:5.0-12.3)with acute cholecystitis undergoing SA cholecystectomy,one patient will suffer a complication.CONCLUSION Patients with Tokyo Grade 2 acute cholecystitis had more complications and increased hospital charges when undergoing SA cholecystectomy.This data supports a selective approach to SA cholecystectomy for acute cholecystitis. | Christopher P Rice Krishnamurthy B Vaishnavi Celia Chao Daniel Jupiter August B Schaeffer Whitney R Jenson Lance W Griffin William J Mileski | 2019 | World Journal of Gastroenterology2019，25，48： | 8 |
| 2 | Posterior dislocation of the elbow with fractures of the radial head and coronoid显示文摘 | Ring D Jupiter JB Zilberfarb J | 2002 | J Bone Joint Surg Am2002，84，4： | 1 |
| 3 | Posterior dislocation of the elbow with fractures of the radial head and coronoid显示文摘 | Ring D Jupiter JB Zilberfarb J | 2002 | Bone Joint Surg Am(Am)2002，84，4： | 1 |
| 4 | Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius显示文摘 | RING D PROMMERSBERGER K JUPITER J B | 2004 | J Bone Joint Surg Am2004，86，8： | 1 |
| 5 | Coronal shear fractures of the distal end of the humerus显示文摘 | McKee M D Jupiter J B Bamberger H B | 1996 | J Bone Joint Surg Am1996，78，1： | 1 |
| 6 | Posterior dislocation of the elbow with fractures of the radial head and coronid显示文摘 | Ring D Jupiter JB Zilberfarb J | 2002 | J Bone Joint Surg(Am)2002，84，4： | 1 |
| 7 | Intra-articular frature of the distal end of the radius in young adults 显示文摘 | Knirk J Jupiter JR | 1986 | J Bone Joint surg(Am)1986，68，： | 1 |
| 8 | Reconstruction for Post-trau- matic Condition of the Elbow Joint显示文摘 | Modabber M R Jupiter J B | 1995 | J Bone Joint Surg AM1995，77，9： | 1 |
| 9 | Open reduction and internal fixation of fractures of the radial head显示文摘 | Ring D Quintero J Jupiter JB | 2002 | J Bone Joint Surg Am2002，84，1： | 1 |
| 10 | Hand and foot abnormalities associated with genetic diseases显示文摘 | Mankin H J Jupiter J Trahan CA | 2011 | Hand (N Y)2011，6，1： | 1 |
| 11 | Intra - articular fractures of the distal radius : bridging external fixation in slight flexion and ulnar deviation along articular surface instead of radial shaft 显示文摘 | MORADI A EBRANIMZADEN M H JUPITER J B | 2014 | Techniques in Hand & Upper Extremity Surgery2014，18，1： | 1 |
| 12 | Free flaps to preserve below-knee amputation stumps:longterm evaluation显示文摘 | Gallico GG Ehrlichman RJ Jupiter J | 1987 | Plust Reconstr Surg1987，79，： | 1 |
| 13 | The rationale for precise management of distal radial fractures 显示文摘 | Ark J Jupiter JB | 1993 | Orthop Clin North Am1993，24，2： | 1 |
| 14 | Prospective muhieenter trial of a PJale for dorsal fixation of distal radius fracture显示文摘 | Ring D Jupiter JB Brennwald J | 1997 | J Hand Surg(Am)1997，22，5： | 1 |
| 15 | Posterior dislocation of the elbow with fractures of the radial head and coronoid显示文摘 | Ring D Jupiter J B Zilberfarb J | 2002 | J Bone Joint Surg Am2002，84，4： | 1 |
| 16 | Posterior dislocation of the el-bow with fractures of the radial head and coronoid 显示文摘 | Ring D Jupiter J B Zilberfarb J | 2002 | J BoneJoint Surg Am2002，84，4： | 1 |
| 17 | A Histologic Analysis of the Effects of Stainless Steel and Titanium Implants Adjacent to Tendons: An Experimental Rabbit Study 显示文摘 | Nazzal A Lozano - ealderon S Jupiter J | 2006 | J Hand Surg2006，31，7： | 1 |
| 18 | Intra - articular fractures of the distal end of the radius in young adults 显示文摘 | KNIRK J L JUPITER J B | 1986 | J Bone Joint Surg Am1986，68，5： | 1 |
| 19 | Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures显示文摘 | Ring D Jupiter JB Brennwald J | 1997 | J Hand Surg1997，22，5： | 1 |
| 20 | Posterior dislocation of the elbow with fractures of the radial head and coronoid显示文摘 | Ring D Jupiter JB Zilberfarb J | 2002 | J Bone Joint Surg Am2002，84，4： | 1 |
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