Mount Sinai Hospital, Division of Gastroenterology, Toronto, Ontario, Canada.
Gastrointest Endosc. 2012 Jan;75(1):47-55. doi: 10.1016/j.gie.2011.08.028. Epub 2011 Nov 17.
Cholecystectomy is recommended during hospitalizations for acute biliary pancreatitis (ABP).
We sought to assess the population-based effectiveness of index cholecystectomy by using nationwide data.
Retrospective, cohort study.
All acute-care hospitals in Canada from 2007 to 2010.
This study involved patients admitted for ABP in the Canadian Institutes for Health Information hospital discharge database.
Cholecystectomy and therapeutic ERCP during the index admission.
Rate of hospital readmissions for ABP.
Among 5646 patients with ABP, 32% underwent cholecystectomy and 22% ERCP during the index admissions. Patients admitted to hospitals in the highest quartile for cholecystectomy volume were more than 10-fold likely to undergo cholecystectomy during the index admission (adjusted odds ratio 11.0; 95% confidence interval [CI], 7.4-16.5). The 12-month readmission rate for ABP was lower with cholecystectomy (5.6% vs 14.0%; P < .0001) and therapeutic ERCP (5.1% vs 13.1%; P < .0001). After multivariate adjustment, lower readmission rates were independently associated with both cholecystectomy (adjusted hazard ratio [HR] 0.39; 95% CI, 0.32-0.48) and ERCP (adjusted HR 0.37; 95% CI, 0.29-0.50). After excluding early readmissions (within 28 days of discharge), the adjusted HR for cholecystectomy was 0.43 (95% CI, 0.34-0.57). The admitting hospital's cholecystectomy volume was inversely associated with 12-month readmission rates for ABP (quartile 1, 15.9%; quartile 2, 13.9%; quartile 3, 11.3%; quartile 4, 10.0%; P < .001).
The study was based on hospital administrative data.
Cholecystectomy and ERCP during the index admission were associated with reduced readmission rates for ABP, providing population-based evidence to support consensus guidelines that recommend early biliary intervention.
胆囊炎推荐在急性胆源性胰腺炎（ABP）住院期间进行手术切除。
我们旨在利用全国性数据评估索引性胆囊切除术的人群效果。
回顾性队列研究。
2007 年至 2010 年加拿大所有急性护理医院。
这项研究涉及加拿大卫生信息研究所住院患者数据库中因 ABP 入院的患者。
在指数入院期间进行胆囊切除术和治疗性 ERCP。
ABP 的医院再入院率。
在 5646 例 ABP 患者中，32%的患者在指数入院期间接受了胆囊切除术，22%的患者接受了 ERCP。在胆囊切除术量最高的四分位医院入院的患者，在指数入院期间接受胆囊切除术的可能性要高出 10 倍以上（调整后的优势比 11.0；95%置信区间 [CI]，7.4-16.5）。胆囊切除术（5.6%比 14.0%；P<.0001）和治疗性 ERCP（5.1%比 13.1%；P<.0001）可降低 12 个月的 ABP 再入院率。经多变量调整后，胆囊切除术（调整后的危害比 [HR] 0.39；95%CI，0.32-0.48）和 ERCP（调整后的 HR 0.37；95%CI，0.29-0.50）均与较低的再入院率独立相关。在排除了早期再入院（出院后 28 天内）后，胆囊切除术的调整后 HR 为 0.43（95%CI，0.34-0.57）。入院医院的胆囊切除术量与 ABP 的 12 个月再入院率呈负相关（四分位 1，15.9%；四分位 2，13.9%；四分位 3，11.3%；四分位 4，10.0%；P<.001）。
该研究基于医院行政数据。
指数入院期间的胆囊切除术和 ERCP 与 ABP 的再入院率降低相关，为支持推荐早期胆道干预的共识指南提供了人群证据。
