González-Muñoz Juan Ignacio, Angoso María, Sayagués José María, Sánchez-Casado Ana Belén, Hernández Alvaro, Velasco Antonio, Muñoz-Bellvis Luís
Department of General and Digestive Surgery, University Hospital of Salamanca-IBSAL, Paseo de San Vicente 58-182, 37007, Salamanca, Spain,
Langenbecks Arch Surg. 2014 Dec;399(8):1065-70. doi: 10.1007/s00423-014-1245-z. Epub 2014 Sep 13.
Therapeutic recommendations of acute cholecystitis are not consistently implemented, which generates greater patient morbidity and higher health care costs. The aim of this article is to evaluate the burden of acute cholecystitis, to detect potentially modifiable variables, and to propose a therapeutic strategy that will allow us to improve the quality of care.
We carried out a retrospective study of patients who were admitted to the hospital from January 2010 to December 2012 using a univariate analysis of parameters including the admitting department, age, treatment administered, and length of stay.
A total of 967 patients were admitted to the hospital with a diagnosis of acute cholecystitis, 692 (72%) to the Surgery Department, 257 (26%) to Internal Medicine-Digestive, and 18 (2%) to other departments. Four hundred ninety-eight (51.5%) were operated on: 107 (21%) on an urgent basis, 111 (22%) at an early stage (<96 h at diagnosis), 152 (30%) at a late stage (>96 h at diagnosis), and 128 (26%) at a delayed date (other admission). Patients who were admitted into the surgery department were five times more likely to be operated on than patients admitted into other departments (p<0.01). Patients operated on at a late stage had a longer length of stay than early stage surgery patients (p<0.05) and than non-operated ones (p<0.05). Patients<74 years old were more frequently operated than older ones (p<0.05).
The non-standardized treatment of acute cholecystitis causes high clinical and surgical variability, long average stay, more readmissions, and high hospital costs. Therefore, patients with a diagnosis of acute cholecystitis should be admitted to the Surgery Department, thereby increasing the probability of receiving definite treatment.
急性胆囊炎的治疗建议未能始终得到贯彻执行，这导致患者发病率更高，医疗成本更高。本文旨在评估急性胆囊炎的负担，发现潜在的可改变变量，并提出一种治疗策略，以提高医疗质量。
我们对2010年1月至2012年12月期间入院的患者进行了回顾性研究，对包括收治科室、年龄、所接受的治疗以及住院时间等参数进行单因素分析。
共有诊断为急性胆囊炎的96名患者入院，其中692名（72%）入住外科，257名（26%）入住消化内科，18名（2%）入住其他科室。498名（51.5%）接受了手术：107名（21%）为急诊手术，111名（22%）为早期手术（诊断后<96小时），152名（30%）为晚期手术（诊断后>96小时），128名（26%）为延迟手术（其他入院情况）。入住外科的患者接受手术的可能性是入住其他科室患者的五倍（p<0.01）。晚期接受手术的患者住院时间比早期手术患者长（p<0.05），也比未接受手术的患者长（p<0.05）。74岁以下的患者比年龄较大的患者接受手术的频率更高（p<0.05）。
急性胆囊炎的非标准化治疗导致临床和手术差异大、平均住院时间长、再入院率高以及医院成本高。因此，诊断为急性胆囊炎的患者应入住外科，从而增加接受确定性治疗的可能性。
