Br J Surg. 2016 Nov;103(12):1716-1726. doi: 10.1002/bjs.10288. Epub 2016 Oct 17.
The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.
Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).
Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m , who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.
Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.
本前瞻性基于人群的队列研究旨在确定与急诊胆囊切除术相关的患者和医院特征，并探讨这些因素对医院间差异的影响。
2014 年 3 月 1 日至 5 月 1 日期间，在英国和爱尔兰的急性医院连续收集接受胆囊切除术的患者数据。采用两级层次结构（患者为一级，医院为二级）的多水平多变量逻辑回归模型分析影响急诊胆囊切除术的潜在解释变量。
共纳入了 165 家医院的 4744 例胆囊切除术患者。结果显示，年龄增长、ASA 体能状况分级降低、胆绞痛、需要进一步影像学检查（磁共振胰胆管成像）、内镜介入治疗（内镜逆行胰胆管造影）以及住院于非胆道中心显著降低了行急诊胆囊切除术的可能性。该多水平模型用于计算年龄在 40 岁及以上、ASA 分级为 I 或 II 级、BMI 至少为 25.0kg/m²、表现为急性胆囊炎且超声检查显示胆囊壁厚、胆总管正常的女性接受急诊胆囊切除术的概率。预计接受急诊胆囊切除术的平均概率为 0.52（95%可信区间为 0.45 至 0.57）。165 家医院的预测概率从 0.02 到 0.95 不等，表明医院间存在显著差异。
患有相似特征的患者在不同的医院就诊时，并未得到可比的治疗。
