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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 | Recognizes veterinary shortage in public health 显示文摘 | JESSUP D A KARESH W B LANCE W R | 2005 | J Am Vet bled Assoc2005，227，3： | 1 |
| 3 | Experimental and theoretical investigation of ground effect at low reynolds numbers显示文摘 | Justin Gross Lance W Traub | 2012 | Journal of Aircraft2012，49，2： | 1 |
| 4 | Assessment Center Exercise Factors Represent Cross-situational Specificity,not Method Bias显示文摘 | Lance C E Newbolt W H Gatewood R D | 2000 | Human Performance2000，13，4： | 1 |
| 5 | Familial paroxysmal dystonic chreoathetosis and its differential from related syndromes 显示文摘 | Lance J W | 1997 | Ann Neurol1997，2，4： | 1 |
| 6 | Hounsfield unit density accurately predicts ESWL success显示文摘 | Maqnuson W J Tomera K M Lance R S | 2005 | Alaska Med2005，47，2： | 1 |
| 7 | The association be- tween telomerase, p53 and clinical staging in eolorectal cancer 显示文摘 | BROWN T ALDOUS W LANCE R | 1998 | Am J Surg1998，175，5： | 1 |
| 8 | The protein reserves of the barley grain and their degradation during malting and brewing显示文摘 | WALLACE W LANCE R C M | 1988 | J Inst Brew1988，96，： | 1 |
| 9 | 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 |
| 10 | Bound and free forms of barley limit dextrinase显示文摘 | SISSONS M J LANCE R C WALLACE W | 1994 | Cereal Chemical1994，71，5： | 1 |
| 11 | Adult prostate sarcoma:The anderson cancer center experience显示文摘 | Sexton W J Lance R E Reyes A O | 2001 | J Urol2001，166，： | 1 |
| 12 | Multifactor dimensionality reduction software for detecting gene - gene and gene - enviroment interactions 显示文摘 | Lance W Hahn | 2003 | Bioinformactics2003，19，： | 1 |
| 13 | Experimental Investigation of the Effect of Trip Strips at Low Reynolds Number显示文摘 | Lance W Traub | 2011 | Journal of Aircraft2011，48，5： | 1 |
| 14 | Biodiesel production by simultaneous extraction and conversion of total lipids from microal- gae, cyanobacteria, and wild mixed - cultures 显示文摘 | Bradley D W Robert M W Lance C S | 2011 | Bioresource Technology2011，102，： | 1 |
| 15 | Tripartite quantum state sharing显示文摘 | Lance A M Symul T Bowen W P | 2004 | Phys Rev Lett2004，92，17： | 1 |
| 16 | Tripartite quantum state sharing 显示文摘 | Lance A M Symul T Bowen W P | 2004 | Physical Review Letters2004，92，01： | 1 |
| 17 | Release and activation of barley beta-amylase by malt endopeptidases 显示文摘 | GUERIN J R LANCE R C M WALLACE W | 1992 | Journal of Cereal Science1992，15，1： | 1 |
| 18 | Examining the joint toxicity of chlorpyrifos and atrazine in the aquatic species:Lepomis macrochius,Pimephales promelas and Chironomus tentans显示文摘 | Tyler W Lance J Michael J | | 0，，01： | 1 |
| 19 | Hounsfield u- nit density accurately predicts ESWL success 显示文摘 | Maqnuson W J Tomera K M Lance R S | 2005 | Alas- ka Meal2005，47，2： | 1 |
| 20 | Quantum cryptography without swithching显示文摘 | C Weedbrook A M Lance W P Bowen et aL | 2004 | Phys Rev Lett2004，93，17： | 1 |
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