Michael Pine and Associates, Chicago, IL; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; University of New Mexico School of Medicine, Albuquerque, NM.
Michael Pine and Associates, Chicago, IL; Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL.
Surgery. 2014 Oct;156(4):931-6. doi: 10.1016/j.surg.2014.06.023.
Little information is available about postdischarge adverse events after laparoscopic cholecystectomy.
Inpatient and 90-day postdischarge adverse events were identified for Medicare patients discharged in 2009-2010 after undergoing elective laparoscopic cholecystectomy on day 0, 1, or 2 of hospitalization at facilities that performed 20 or more laparoscopic cholecystectomies during the study period. A predictive length of stay (LOS) linear regression model was derived and used to identify patients with prolonged LOS (prLOS) whose risk-adjusted LOS exceeded a 3σ upper limit on a moving average control chart. Rates of inpatient and 90-day fatal and nonfatal adverse events and interrelationships among different outcomes and alternative outcome measures were explored.
Of 89,639 study cases, 0.7% died during their index hospitalization, and 1.3% died within 90 days of discharge. Of live discharges, 8.0% had prLOS, and 42.1% had coded complication. In the 90 days after discharge, 9,416 (10.6%) were readmitted. Patients who were prLOS outliers were more likely to die or be readmitted than nonoutliers (P < .0001; χ(2)).
More than 18% of Medicare patients undergoing presumably low-risk elective inpatient laparoscopic cholecystectomy died, had a severe inpatient complication, or were readmitted within 90 days of discharge.
腹腔镜胆囊切除术出院后的不良事件信息有限。
对 2009 年至 2010 年期间在住院天数为 0、1 或 2 天接受择期腹腔镜胆囊切除术的医疗保险患者进行了住院和出院后 90 天不良事件的识别，这些患者在进行 20 次或更多腹腔镜胆囊切除术的医疗机构出院。导出了一个预测住院时间（LOS）的线性回归模型，并用于识别 LOS 延长（prLOS）患者，其风险调整的 LOS 超过移动平均控制图的 3σ上限。探讨了住院和 90 天内致命和非致命不良事件的发生率以及不同结局和替代结局测量之间的相互关系。
在 89639 例研究病例中，有 0.7%的患者在住院期间死亡，有 1.3%的患者在出院后 90 天内死亡。存活出院患者中，有 8.0%的患者出现 prLOS，有 42.1%的患者出现编码并发症。出院后 90 天内，有 9416 例（10.6%）再次入院。与非离群值患者相比，prLOS 离群值患者更有可能死亡或再次入院（P<0.0001；χ(2)）。
超过 18%的接受低风险择期住院腹腔镜胆囊切除术的医疗保险患者在出院后 90 天内死亡、出现严重的院内并发症或再次入院。
