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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 | ACC/AHA guidelines for the management of patients with unstable angina and non–st-segment elevation myocardial infarction显示文摘 | Eugene Braunwald Elliott M Antman John W Beasley Robert M Califf Melvin D Cheitlin Judith S Hochman Robert H Jones Dean Kereiakes Joel Kupersmith Thomas N Levin Carl J Pepine John W Schaeffer Earl E Smith David E Steward Pierre Theroux Raymond J Gibbons J | 2000 | Journal of the American College of Cardiology2000，，3： | 4 |
| 3 | Measuring ecosystem health显示文摘 | Schaeffer D J Henricks E E Kerster H W | 1998 | Environmental Management1998，12，： | 2 |
| 4 | Estimating the carbon footprint of telecommunications products: a heuris- tic approach显示文摘 | JOYEE T OKRASINSKI T A SCHAEFFER W | 2010 | Jorunal of Mechanical Design2010，132，9： | 1 |
| 5 | Establishment and characterization of bovine mammary myoepithelial cell line 显示文摘 | Zavizion B van Duffelen M Schaeffer W | 1996 | In Vitro Cell Dev Biol-Anim1996，32，： | 1 |
| 6 | Prevention of bronchopulmonary dysplasia by administration of bovine superoxide dismutase in preterm infants with respiratory distress syndrome显示文摘 | Evans H Concepcion L Jhaveri R Schaeffer H Friedman A | 1984 | J Pediatr1984，105，78： | 1 |
| 7 | Ecosystem health: measuring ecosystem health 显示文摘 | SCHAEFFER D J HENRICKS E E KERSTER H W | 1988 | Environmental Management1988，12，4： | 1 |
| 8 | Aza uracil and related nucleicacid analogs as inhibitors of axillary bud growth in tobacco显示文摘 | Schaeffer G W G L Steffens | 1965 | Tobacco Science1965，，9： | 1 |
| 9 | Cyanide phytoremediation by water byacinths ( Eichhornia crassipes ) 显示文摘 | Ebel M Evangelou M W H Schaeffer A | 2007 | Chemosphere2007，66，： | 1 |
| 10 | The influence of humic acids on the phytoextraction of cadmium from soil 显示文摘 | Evangelou M W Daghan H Schaeffer A | 2004 | Chemosphere2004，57，： | 1 |
| 11 | Ecosystem health Measuring ecosystem health显示文摘 | SCHAEFFER D J’HENRICKS E E KERSTER H W | 1988 | Environ Man1988，，12： | 1 |
| 12 | Chelate As- sisted Phytoextraction of Heavy Metals From Soil: Effect, Mechanism, Toxicity, and Fate of Chelating Agents显示文摘 | Evangelou M W Ebel M Schaeffer A | 2007 | Chemosphere2007，68，6： | 1 |
| 13 | Deficiency of survivin in transgenic mice exacerbates Fas induced apoptosis via mitochondrial pathways显示文摘 | Conway EM Pollefeyt S Steiner - Mosonyi M Lno W Dereriese A Lupu F Bono F Leducq N Dol F Schaeffer P Collen D Herbet JM | 2002 | Gastroenterology2002，123，： | 1 |
| 14 | Increased of neuronspecific enolase in patients with Creutzfeldt-Jakob disease显示文摘 | Kropp S Zerr I Schaeffer S W J | 1999 | Neurosci Lett1999，261，12： | 1 |
| 15 | Ecosystem health: measuring ecosystem health 显示文摘 | Schaeffer D J Henficks E E Kerster H W | 1998 | Environ Manag1998，12，： | 1 |
| 16 | Insights into Alzheimer disease pathogenesis from studies in transgenic an- imal models 显示文摘 | Schaeffer E L Figueiro M Gattaz W F | 2011 | Cncs2011，66，1： | 1 |
| 17 | Effects of atrazine on amphibian growth and survival in artifi- cial aquatic communities 显示文摘 | Diana S G Restrains W J Schaeffer D J | 2000 | Environmental Toxicology & Chemistry2000，19，： | 1 |
| 18 | How nano m'e nanocomposites 显示文摘 | Schaeffer D W Justice R S | 2007 | Macromolecules2007，40，24： | 1 |
| 19 | Ecosystem health:measuring ecosystem health显示文摘 | Schaeffer D J Henricks E E Kerster H W | 1988 | Journal of Environmental Management1988，12，： | 1 |
| 20 | Arsenic speciation in freshwater organisms from the river Danube in Hungary显示文摘 | Schaeffer R Francesconi K A Kienzl N Soeroes C Fodor P Váradi L Raml R Goessler W Kuehnelt D | | 0，，04： | 1 |
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