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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 | 9-(2- hydroxyethoxymethyl) guanine activity against viruses of the herpes group显示文摘 | Schaeffer H J Beauehamp L Miranda P de | 1978 | Nature1978，272，： | 1 |
| 3 | Factor Xa activates endothelial cells by a receptor cascade between EPR-1 and PAR2显示文摘 | Bono F Schaeffer P Herault J P | 2000 | Arterioscler Thromb Vasc Biol2000，20，11： | 1 |
| 4 | PGC-1a coactivates PDK4 gene phan nuclear receptor ERRα: a expression via the or for tran scriptional control of muscle glucose metabolism 显示文摘 | WENDE A R HUSS J M SCHAEFFER P J | 2005 | Mol Cell Biol2005，25，10： | 1 |
| 5 | Greenhouse gas emissions from hydroelectric reserw~irs 显示文摘 | ROSA L P SCHAEFFER R | 1994 | Ambio1994，23，： | 1 |
| 6 | A role for the transcriptional coactivator PGC-lalpha in muscle refueling 显示文摘 | Wende A R Schaeffer P J Parker G J | 2007 | J Biol Chem2007，282，36： | 1 |
| 7 | A novel series of benzo- hopanes widespread in sediments 显示文摘 | Schaeffer P Adrna P Trendel J M et ai | 1995 | Organic Geochemistry1995，23，1： | 1 |
| 8 | Experimental autoimmune prostatitis induces chronic pelvic pain显示文摘 | Rudick C N Schaeffer A J Thumbikat P | 2008 | Am J Physiol Regul Integr Comp Physiol2008，294，： | 1 |
| 9 | Role of hyperglucagonemia in maintenance of increased rates of hepatic glucose output in type Ⅱ diabetics 显示文摘 | BARON AD SCHAEFFER L SHRAGG P | 1987 | Diabetes1987，36，3： | 1 |
| 10 | Fusion of bacterial protoplasts显示文摘 | Schaeffer P B Hothkiss R D | 1976 | Proc Natl Acad Sci USA1976，3，6： | 1 |
| 11 | Role of mast cells in male chronic pelvic pain显示文摘 | Done J D Rudick C N Quick M L Schaeffer A J Thumbikat P | 2012 | J Urol2012，187，： | 1 |
| 12 | Electrically induced structure formation and pattern transfer显示文摘 | Erik Schaeffer Thomas Thum-Albrecht Thomas P Russell | | 0，，： | 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 | Biomarker evidence for a major preservation pathway of sedimentary organic carbon 显示文摘 | Hebting Y Schaeffer E Behrens A Adam E Schmitt G Schneckenburger P Bernasconi S M Albrecht P | 2006 | Science2006，312，16： | 1 |
| 15 | Fusion of bacterial protoplasts 显示文摘 | SCHAEFFER P CAMI B HOTCHKISS R D | 1976 | Proc Natl Acad Sci USA1976，73，6： | 1 |
| 16 | Okenane, a biomarker for purple sulfur bacteria (Chromatiaceae), and other new- carotenoid derivatives from the 1640 Ma Barney Creek Formation 显示文摘 | Brocks J J Schaeffer P | 2008 | Geochim Cosmochim Acta2008，72，13： | 1 |
| 17 | Large and rapid climatevariability during the Messinian salinity crisis: Evidence fromdeuterium concentrations of individual biomarkers 显示文摘 | Andersen N Paul H A Bernasconi S M McKenzie J A Behrens A Schaeffer P Albrecht P | 2001 | Geology2001，29，79： | 1 |
| 18 | Synergy of entry inhibitors with direct-Acting antivirals uncovers novel combinations for prevention and treatment of hepatitis C显示文摘 | Xiao F Fofana I Thumann C Mailly L Alles R Robinet E Meyer N Schaeffer M Habersetzer F Doffol M Leyssen P Neyts J Zeisel M B Baumert T F | 2014 | Gut2014，，： | 1 |
| 19 | Behavior of land developers: planning and the economics of information显示文摘 | Schaeffer P V hopkins L D | 1987 | Environment and Planning A1987，，19： | 1 |
| 20 | Les Schizosaccharomyces en Oenologie显示文摘 | Bidan P Meyer J P Schaeffer A | 1974 | Bull O I V1974，47，： | 1 |
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