典型文献
Call for action: Increased healthcare utilization with growing use of percutaneous cholecystectomy tube over initial cholecystectomy in cirrhotics
文献摘要：
Background: Acute calculous cholecystitis (ACC) is frequently seen in cirrhotics, with some being poor candidates for initial cholecystectomy. Instead, these patients may undergo percutaneous cholecystostomy tube (PCT) placement. We studied the healthcare utilization and predictors of cholecystectomy and PCT in patients with ACC.Methods: The National Database was queried to study all cirrhotics and non-cirrhotics with ACC between 2010–2014 who underwent initial PCT (with or without follow-up cholecystectomy) or cholecystectomy. Cirrhotic patients were divided into compensated and decompensated cirrhosis. Independent predictors and outcomes of initial PCT and failure to undergo subsequent cholecystectomy were studied. Results: Out of 919189 patients with ACC, 13283 (1.4％) had cirrhosis. Among cirrhotics, cholecystec- tomy was performed in 12790 (96.3％) and PCT in the remaining 493 (3.7％). PCT was more frequent in cirrhotics (3.7％) than in non-cirrhotics (1.4％). Multivariate analyses showed increased early readmis- sions [odds ratio (OR) = 2.12, 95％ confidence interval (CI): 1.43–3.13, P < 0.001], length of stay (effect ratio = 1.39, 95％ CI: 1.20–1.61, P < 0.001), calendar-year hospital cost (effect ratio = 1.34, 95％ CI: 1.28–1.39, P < 0.001) and calendar-year mortality (hazard ratio = 1.89, 95％ CI: 1.07–3.29, P = 0.030) in cir- rhotics undergoing initial PCT compared to cholecystectomy. Decompensated cirrhosis (OR = 2.25, 95％ CI: 1.67–3.03, P < 0.001) had the highest odds of getting initial PCT. Cirrhosis, regardless of compensated (OR = 0.56, 95％ CI: 0.34–0.90, P = 0.020) or decompensated (OR = 0.28, 95％ CI: 0.14–0.59, P < 0.001), reduced the chances of getting a subsequent cholecystectomy. Conclusions: Cirrhotic patients undergo fewer cholecystectomy incurring initial PCT instead. Moreover, the rates of follow-up cholecystectomy are lower in cirrhotics. Increased healthcare utilization is seen with initial PCT amongst cirrhotic patients. This situation reflects suboptimal management of ACC in cirrhotics and a call for action.
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作者姓名：
Srikanth Vedachalam;Sajid Jalil;Somashaker G Krishna;Kyle Porter;Na Li;Sean G Kelly;Lanla Conteh;Khalid Mumtaz
作者机构：
Department of Internal Medicine,The Ohio State University Wexner Medical Center,Columbus,OH 43210,USA;Division of Gastroenterology,Hepatology and Nutrition,The Ohio State University Wexner Medical Center,Columbus,OH 43210,USA;Center for Biostatistics,Department of Biomedical Informatics,The Ohio State University Wexner Medical Center,Columbus,OH 43210,USA
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引用格式：
[1]Srikanth Vedachalam;Sajid Jalil;Somashaker G Krishna;Kyle Porter;Na Li;Sean G Kelly;Lanla Conteh;Khalid Mumtaz-.Call for action: Increased healthcare utilization with growing use of percutaneous cholecystectomy tube over initial cholecystectomy in cirrhotics)[J].国际肝胆胰疾病杂志(英文版),2022(01):56-62
A类：
cirrhotics,calculous,cholecystostomy,readmis,rhotics,Decompensated
B类：
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AB值：
0.421047
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