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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 | Molecular and virologic characteristics of lymphoid malignancies in children with AIDS显示文摘 | McClure K L Leach C T Jenson H B | 2000 | J Acquir Immune Defic Syndr2000，23，： | 1 |
| 3 | Human papillomavirus infection of the cervix:relative risk associations of 15 common anogenital types显示文摘 | Lorincz A T Reid R Jenson A B | 1992 | Obstet Gynecol1992，79，： | 1 |
| 4 | Ferrous sulfate oxidation using Thiobacillus ferrooxidans :a review显示文摘 | Jenson A B and Webb C | 1995 | Process Biochemistry1995，30，3： | 1 |
| 5 | Chemistry and properties of a phenylethynyl-terminated polyimide显示文摘 | Bryant R G Jenson B J Hergenrother P M | 1996 | Journal of Applied Polymer Science1996，59，8： | 1 |
| 6 | A comparison of the thermocouple psychrometer and the pressure plate methods for determination of soil water characteristic curves显示文摘 | Madsen H B Jenson C R Boyson T | 1986 | Journal of Soil Science1986，37，3： | 1 |
| 7 | The psychotropic effect of ketamine 显示文摘 | Hansen G Jenson S B Changresh L | 1988 | J Psychoact Drugs1988，20，4： | 1 |
| 8 | CXCR4 expres- sion in ovarian cancer is associated with peritoneal dis- semination显示文摘 | Bruneau DJ Clark LJ Jenson B | 2004 | Proc AACR2004，45，： | 1 |
| 9 | Substrate interactions of benzene,toluene, and paraxylene during microbial degradation by pure cultures and mixed culture aquifier slurries显示文摘 | Jenson B K Gundersen A T 1989 | 1989 | Appl Environ Microbiol1989，57，： | 1 |
| 10 | Lysine needs of rapidly growing turkeys from 12 - 22 weeks of age显示文摘 | Jenson L S Manning B Falen L | 1976 | Poultry Science1976，55，： | 1 |
| 11 | Evaluation of the effect of smokeless tobacco purified products and extracts on latent Epstein-Barr virus显示文摘 | Jenson H B Heard P Moyer M P | 1999 | Toxicology1999，133，1： | 1 |
| 12 | Dynamic model for vacuum freeze - drying of waterlogged archaeological wooden artifacts显示文摘 | Jenson P Jensen J B | 2006 | J Cult Herit2006，7，： | 1 |
| 13 | A new method for the estimation of mutan streptococcue in human salive 显示文摘 | Bratthall S | 1989 | J Dent Ren1989，68，： | 1 |
| 14 | Phosphorus cycling in a coastal marine sediment, Aarthus Bay,Denmark 显示文摘 | JENSON H S MORTENSEN P B ANDERSEN F | 1995 | Limnol Oceanogr1995，40，5： | 1 |
| 15 | In situ characterization of the oxidative degradation of a polymeric light emitting device显示文摘 | CUMPSTON B H PARKER I D JENSON K F | 1997 | Journal of Applied Physics1997，81，8： | 1 |
| 16 | The psychotropic effect of ketamine显示文摘 | Hansen G Jenson S B Changresh L | 1988 | Psychoact Drugs1988，20，4： | 1 |
| 17 | Role of poloxamer 188 during recovery from ischemic spinal cord injury:a preliminary study显示文摘 | Jenson B Blisard K | 1996 | J Invest Surg1996，9，2： | 1 |
| 18 | Caries risk assessment in practice for age 6 through adult显示文摘 | FEATHERSTONE J D B DOMEJEAN O S JENSON L | 2007 | J Cal Dent Assoc2007，35，10： | 1 |
| 19 | Plants and productivity in international trade显示文摘 | Bernard A B J Eaton J B Jenson S Kortum | 2003 | American E- conomic Review2003，93，： | 1 |
| 20 | Nelson textbook of pediatrics显示文摘 | Behrman R E Kliegman R M Jenson H B | 2007 | Philadelphia Saunders2007，23，： | 1 |
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