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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 | Sciatic nerve injuries in revision total hip arthroplasty 显示文摘 | Peters Lance E Buly Sculco Thomas P | 2001 | Techniques in Orthopaedics2001，16，3： | 2 |
| 3 | The application of SHRIMP to Phanerozoic geochronology: a critical appraisal of four zircon standards显示文摘 | Lance P Black Sandra L Kamo lan S Williams | 2003 | Chemical Geology2003，200，： | 1 |
| 4 | Testicular regulation in nonmammalian vertebrates显示文摘 | Callard I P Callard G V Lance V | 1978 | Biol Reprod1978，18，1： | 1 |
| 5 | Costs of clinical mastitis and mastitis prevention in dairy herds显示文摘 | Miller G Y Bartlett P C Lance S E | | 0，，： | 1 |
| 6 | Static and dy- namic shoulder stabilizer adaptations in javelin throwers: A preliminary study显示文摘 | EDOUARD P DAMOTTE A LANCE G | 2013 | Isok Exe Sci2013，21，1： | 1 |
| 7 | Slope stability analysis by finite elements显示文摘 | Griffiths D V Lanc P A | | 0，，03： | 1 |
| 8 | Telomerase can inhibit the recombination-based pathway of telomere maintenance in human cells 显示文摘 | Lance P F Ying Z Krisztina P | 2001 | J Biol Chem2001，276，32： | 1 |
| 9 | The Application of SHRIMP to Phanerozoic geochronology; a critical appraisal of four zircon standards显示文摘 | Lance P Black Sandra L Kamo Ian S Williams | 2003 | Chemical Geology2003，200，： | 1 |
| 10 | Fixation failure in femoral neck fractures显示文摘 | Lance S Estrada David A Volgas James P Stannard | 2002 | Clinical Orthopaedics and Related Research2002，399，： | 1 |
| 11 | Evidence for nanoindentation-induced phase transformations in germanium 显示文摘 | Jang J lance M J Wen S P | 2005 | Applied Physics Letters2005，1319，： | 1 |
| 12 | Genetic models for quantitatively inherited endosperm characters 显示文摘 | Bogyo T P Lance R C | 1998 | Heredity1998，60，： | 1 |
| 13 | A Distributed Hydrology-Vegetation Model for Complex Terrain 显示文摘 | Mark S W Lance W V Dennis P L | 1994 | Water Resources Research1994，30，6： | 1 |
| 14 | The Application of SHRIMP to Phanerozoic geochronology: a critical appraisal of four zircon standards显示文摘 | Lance P B Sandra L K Ian S Williams | 2003 | Chemical Geology2003，200，： | 1 |
| 15 | TEMORA 1: a new zircon standard for Phanerozoic U-Pb geochronology显示文摘 | Lance P B Sandra L K Charlotte M A | 2003 | Chemical Geology2003，200，： | 1 |
| 16 | Root aeration improves yield and water use efficiency of tomato in heavy clay and saline soils 显示文摘 | Bhattarai S P Lance P Midmore D J | 2006 | Scientia Horticulturae2006，108，3： | 1 |
| 17 | Colorectal polyps and their relationship to cancer 显示文摘 | Kim EC Lance P | 1997 | Gastroenterol Clin North Am1997，26，： | 1 |
| 18 | Energetics of ammonium per- chlorate decomposition steps显示文摘 | Politzek P Lance P | 1998 | Journal of Mo- lecular Structure Theochem1998，454，： | 1 |
| 19 | TEMORA 1:A New Zircon Standard for Phanerozoic U-Pb Geochronology显示文摘 | Lance P Black Sandra L Kamo Charlotte M Allen | 2003 | Chem Geol2003，200，： | 1 |
| 20 | Tripartite quantum state sharing显示文摘 | Lance A M Symul T Bowen W P | 2004 | Phys Rev Lett2004，92，17： | 1 |
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