Department of Surgery, Division of General Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L223A, Portland, OR 97239, USA.
J Gastrointest Surg. 2009 Dec;13(12):2292-301. doi: 10.1007/s11605-009-0988-2. Epub 2009 Sep 2.
This study aims to determine the mortality rate and significant factors associated with laparoscopic (LC) and open cholecystectomies (OC) over a 10-year period.
Using the Nationwide Inpatient Sample, we analyzed data for both LC and OC between 1997 and 2006. Cholecystectomies performed as part of another primary procedure were excluded. Using procedure-specific codes, we calculated annual national volumes for both open and laparoscopic cholecystectomies for the time period under review and the associated in-hospital mortality following both of these procedures. Using logistic regression modeling, we then analyzed selected patient and institutional characteristics to determine if a significant association existed between these factors and in-hospital mortality.
There was a 16% increase in the volume of LC and a corresponding decrease in open procedures over the 10 years under review. In 2006, 12% of cholecystectomies were still performed using an open approach and the associated mortality remained significantly higher than that seen with LC. Overall, after adjusting for patient and hospital characteristics, the mortality for OC was higher than that for LC (OR 4.57; 95% CI, 4.37-4.79, p < 0.001). Age (>60 years), male gender, non-elective admission, admission source, and a primary diagnosis other than cholelithiasis were all independently associated with increased mortality. The average mortality rate associated with conversion from LC to OC was found to be 0.7%.
These data indicate an increase in the proportion LCs performed over the years under study with a decrease in the proportion of OCs. However, OCs remain associated with a significant mortality burden when compared with the laparoscopic approach.
本研究旨在确定在 10 年内行腹腔镜（LC）和开腹胆囊切除术（OC）的死亡率和相关的重要因素。
我们使用国家住院患者样本，分析了 1997 年至 2006 年间 LC 和 OC 的数据。排除作为其他主要手术一部分的胆囊切除术。使用特定于手术的代码，我们计算了研究期间 LC 和 OC 的年全国手术量，以及这两种手术后的院内死亡率。然后，我们使用逻辑回归模型分析了选定的患者和机构特征，以确定这些因素与院内死亡率之间是否存在显著关联。
在研究期间，LC 的数量增加了 16%，而开放手术的数量相应减少。2006 年，仍有 12%的胆囊切除术采用开放方式进行，其相关死亡率仍明显高于 LC。总体而言，在调整了患者和医院特征后，OC 的死亡率高于 LC（OR 4.57；95%CI，4.37-4.79，p<0.001）。年龄（>60 岁）、男性、非择期入院、入院来源以及除胆石症以外的主要诊断均与死亡率升高独立相关。LC 转为 OC 的平均死亡率为 0.7%。
这些数据表明，在研究期间，LC 的比例增加，而 OC 的比例减少。然而，与 LC 相比，OC 仍然与显著的死亡率负担相关。
