Timing is everything: outcomes of 30,259 delayed cholecystectomies in New York State
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES(2022)
摘要
Background The timing of cholecystectomy in relation to outcomes has been debated. To our knowledge, there are no large population-based studies looking at outcomes and complications of delayed cholecystectomy [DC] (> 72 h after presentation). This study utilizes a statewide database to determine whether there are differences in patient outcomes for DC performed at 3–4 days, 5–6 days, and ≥ 7 days after presentation. Methods The New York SPARCS database was used to identify adult patients presenting with a diagnosis of acute cholecystitis from 2005 to 2017. Patients aged < 18, those with missing identifier or procedure-date information, those who underwent early cholecystectomy < 72 h or upon readmission, were excluded. Patients undergoing DC at 3–4 days, 5–6 days, and ≥ 7 days were compared in terms of overall complications, hospital length of stay (LOS), 30-day readmissions/emergency department (ED) visits, and 30-day mortality. Results 30,259 patients were identified. DCs were performed within 3–4 days ( n = 19,845, 65.6%), 5–6 days ( n = 6432, 21.3%), and ≥ 7 days ( n = 3982, 13.2%). There was a stepwise deterioration in outcomes with increased delay to surgery (Fig. 1). When comparing 3–4 and ≥ 7 days, overall complications (OR = 0.418, 95% CI: 0.387–0.452), 30-day readmissions (OR = 0.609, 95% CI: 0.549–0.674), 30-day ED visits (OR = 0.697, 95% CI: 0.637–0.763), 30-day mortality (OR = 0.601, 95% CI: 0.400–0.904), and LOS (OR = 0.729, 95% CI: 0.710–0.748) were lower in the 3–4 day cohort. Conclusions DC within 3–4 days is associated with fewer complications, readmissions and ED visits, and reduced LOS compared to DC at 5–6 or ≥ 7 days after presentation. In addition, 30-day mortality was also significantly different comparing 3–4 with ≥ 7-day cohorts. These data are important for guiding patients in the consent process and may point to choosing an earlier interval cholecystectomy for high-risk patients. Graphical abstract
更多查看译文
关键词
Acute cholecystitis,Cholecystitis,Cholecystectomy,Delayed cholecystectomy,Outcomes,Hospitalization,Length of stay,Readmission,ED visit,Mortality,Bile duct injury,New York,SPARCS database
AI 理解论文
溯源树
样例
生成溯源树,研究论文发展脉络
Chat Paper
正在生成论文摘要