Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery. Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA.
Surg Endosc. 2018 Apr;32(4):2058-2066. doi: 10.1007/s00464-017-5902-5. Epub 2017 Oct 23.
Biliary colic is a common diagnosis for patients presenting to the emergency department (ED). The purpose of this study is to examine the outcomes of patients coming to the ED with biliary colic.
The NYS longitudinal SPARCS database was used to identify patients presenting to the ED with biliary colic from 2005 to 2014. Through the use of a unique identifier, patients were followed in NYS across multiple institutions. Patients who were lost to follow-up, with duplicated records, and those that underwent percutaneous cholecystectomy tubes were excluded from the analysis.
Between 2005 and 2014, there were 72,376 patients who presented to an ED with biliary colic. The admission rate was 20.7-26.02%. Overall, most patients who presented to the ED did not undergo surgery (39,567, 54.7%), of which 35,204 (89%) had only one ED visit, while 4,363(11%) returned to the ED (≥ 2 visits). Only 3.23-5.51% of patients underwent cholecystectomy at the time of initial presentation. Most subsequent cholecystectomies were performed electively (27.38-52.51%) (See Table 1 in this article). Average time to surgery among patients with elective cholecystectomy was 178.4 days. From the patients who underwent cholecystectomy, 10.35% had cholecystectomy at their first ED visit, 77.7% had cholecystectomy following the first ED visit, and 12% had multiple ED visits prior to surgery. Among patients who were discharged from the ED, 32% had their surgery at a different hospital than index presentation.
A significant portion of patients (48.6%) who present to the ED with biliary colic will not return or have surgery within 5 years. A third of patients who eventually undergo cholecystectomy will go to another hospital for their surgery.
胆绞痛是患者到急诊科就诊的常见诊断。本研究旨在探讨因胆绞痛到急诊科就诊的患者的结局。
利用纽约纵向 SPARCS 数据库，自 2005 年至 2014 年，确定因胆绞痛到急诊科就诊的患者。通过使用唯一标识符，患者在纽约州的多个机构中进行了随访。未随访、重复记录和接受经皮胆囊造瘘管引流术的患者被排除在分析之外。
2005 年至 2014 年间，有 72376 例患者因胆绞痛到急诊科就诊。入院率为 20.7%-26.02%。总体而言，大多数到急诊科就诊的患者未行手术（39567 例，54.7%），其中 35204 例（89%）仅就诊 1 次，4363 例（11%）再次就诊（≥2 次）。初次就诊时行胆囊切除术的患者仅占 3.23%-5.51%。大多数后续胆囊切除术为择期手术（27.38%-52.51%）（见本文表 1）。择期胆囊切除术患者的平均手术时间为 178.4 天。在接受胆囊切除术的患者中，10.35%在首次急诊科就诊时行胆囊切除术，77.7%在首次急诊科就诊后行胆囊切除术，12%在手术前多次急诊科就诊。在从急诊科出院的患者中，32%的患者在索引就诊之外的医院进行手术。
有相当一部分（48.6%）因胆绞痛到急诊科就诊的患者在 5 年内不会再次就诊或接受手术。最终行胆囊切除术的患者中有三分之一会到其他医院进行手术。
