MPA Healthcare Solutions, Chicago, IL, USA; Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
MPA Healthcare Solutions, Chicago, IL, USA; Departments of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; University of New Mexico School of Medicine, Albuquerque, NM, USA.
Am J Surg. 2018 Mar;215(3):367-370. doi: 10.1016/j.amjsurg.2017.09.036. Epub 2017 Oct 24.
Preoperative emergency department (ED) visits may reflect the patient's biliary disease, or may signal unstable comorbid conditions that have relevance following inpatient laparoscopic cholecystectomy (ILC) and outpatient laparoscopic cholecystectomy (OLC) in Medicare patients.
We used the Medicare inpatient and outpatient Limited Datasets to identify elective laparoscopic cholecystectomy patients from 2011 to 2014. ED visits for 30-days before the surgical event were identified and correlated with the probability of patients returning to the ED in the 30-days following the procedure.
A total of 129,377 inpatient and 235,339 outpatient LCs were identified. A total of 20,021 (15.5%) of ILCs and 52,025 (22.1%) of OLCs had 30-day preoperative ED visits. ILCs with any 30-day ED visit preoperatively had an Odds Ratio (OR) that predicted a post-discharge ED visit of 1.85 (95% CI = 1.78-1.92; P < 0.0001). OLCs with any 30-day ED visit preoperatively had an OR for post-discharge ED visit of 1.50 (95% CI = 1.46-1.54; P < 0.0001).
Preoperative ED visits predict postdischarge ED visits for laparoscopic cholecystectomy in Medicare patients.
术前急诊就诊可能反映了患者的胆道疾病，也可能提示住院腹腔镜胆囊切除术（ILC）和门诊腹腔镜胆囊切除术（OLC）后不稳定的合并症，这些情况与 Medicare 患者有关。
我们使用 Medicare 住院和门诊有限数据集，从 2011 年到 2014 年，确定了择期腹腔镜胆囊切除术患者。确定了手术前 30 天的急诊就诊，并将其与术后 30 天内患者返回急诊的概率相关联。
共确定了 129377 例住院和 235339 例门诊 LC。20021 例（15.5%）ILC 和 52025 例（22.1%）OLC 有 30 天术前 ED 就诊。任何 30 天 ED 就诊的 ILC 术前有一个预测术后出院 ED 就诊的比值比（OR）为 1.85（95% CI 1.78-1.92；P<0.0001）。任何 30 天 ED 就诊的 OLC 术前有一个预测术后出院 ED 就诊的 OR 为 1.50（95% CI 1.46-1.54；P<0.0001）。
术前 ED 就诊预测 Medicare 患者腹腔镜胆囊切除术后出院 ED 就诊。
