急性护理手术下急性轻度胆石性胰腺炎的管理：患者应入住外科还是内科？
Management of acute mild gallstone pancreatitis under acute care surgery: should patients be admitted to the surgery or medicine service?
作者信息
Kulvatunyou Narong, Watt John, Friese Randall S, Gries Lynn, Green Donald J, Joseph Bellal, O'Keeffe Terence, Tang Andrew L, Vercruysse Gary, Rhee Peter
机构信息
Division of Acute Care Surgery, Department of Surgery, University of Arizona, Room 5411, 1501 North Campbell Avenue, PO Box 245603, Tucson, AZ 85727-5063, USA.
Division of Acute Care Surgery, Department of Surgery, University of Arizona, Room 5411, 1501 North Campbell Avenue, PO Box 245603, Tucson, AZ 85727-5063, USA.
出版信息
Am J Surg. 2014 Dec;208(6):981-7; discussion 986-7. doi: 10.1016/j.amjsurg.2014.09.003. Epub 2014 Sep 22.
BACKGROUND
We hypothesized that patients with acute mild gallstone pancreatitis (GSP) admitted to surgery (SUR; vs medicine [MED]) had a shorter time to surgery, shorter hospital length of stay (HLOS), and lower costs.
METHODS
We performed chart reviews of patients who underwent a cholecystectomy for acute mild GSP from October 1, 2009 to May 31, 2013. We excluded patients with moderate to severe and non-gallstone pancreatitis. We compared outcomes for time to surgery, HLOS, costs, and complications between the 2 groups.
RESULTS
Fifty acute mild GSP patients were admitted to MED and 52 to SUR. MED patients were older and had more comorbidity. SUR patients had a shorter time to surgery (44 vs 80 hours; P < .001), a shorter HLOS (3 vs 5 days; P < .001), and lower hospital costs ($11,492 ± 6,480 vs $16,183 ± 12,145; P = .03). In our subgroup analysis on patients with an American Society of Anesthesiologists score between 1 and 2, the subgroups were well matched; all outcomes still favored SUR patients.
CONCLUSIONS
Admitting acute mild GSP patients directly to SUR shortened the time to surgery, shortened HLOS, and lowered hospital costs.
背景
我们推测，因急性轻症胆石性胰腺炎（GSP）而入院接受外科治疗（SUR组；与内科治疗[MED组]相比）的患者手术时间更短、住院时间（HLOS）更短且费用更低。
方法
我们对2009年10月1日至2013年5月31日期间因急性轻症GSP接受胆囊切除术的患者病历进行了回顾。我们排除了中度至重度胰腺炎和非胆石性胰腺炎患者。我们比较了两组患者在手术时间、HLOS、费用和并发症方面的结果。
结果
50例急性轻症GSP患者被收入MED组，52例被收入SUR组。MED组患者年龄更大且合并症更多。SUR组患者手术时间更短（44小时对80小时；P <.001），HLOS更短（3天对5天；P <.001），住院费用更低（11,492美元±6,480美元对16,183美元±12,145美元；P =.03）。在我们对美国麻醉医师协会评分为1至2分的患者进行的亚组分析中，亚组匹配良好；所有结果仍有利于SUR组患者。
结论
将急性轻症GSP患者直接收入SUR组可缩短手术时间、缩短HLOS并降低住院费用。
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