Division of Colorectal Surgery, New York Presbyterian Hospital/Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor: 8, New York, NY, 10032, USA.
Department of Surgery and Cancer, Imperial College London, London, UK.
Surg Endosc. 2018 Jul;32(7):3055-3063. doi: 10.1007/s00464-017-6016-9. Epub 2018 Jan 8.
Evidence supports early laparoscopic cholecystectomy for acute cholecystitis. Differences in treatment patterns between the USA and UK, associated outcomes and resource utilization are not well understood.
In this retrospective, observational study using national administrative data, emergency patients admitted with acute cholecystitis were identified in England (Hospital Episode Statistics 1998-2012) and USA (National Inpatient Sample 1998-2011). Proportions of patients who underwent emergency cholecystectomy, utilization of laparoscopy and associated outcomes including length of stay (LOS) and complications were compared. The effect of delayed treatment on subsequent readmissions was evaluated for England.
Patients with a diagnosis of acute cholecystitis totaled 1,191,331 in the USA vs. 288 907 in England. Emergency cholecystectomy was performed in 628,395 (52.7% USA) and 45,299 (15.7% England) over the time period. Laparoscopy was more common in the USA (82.8 vs. 37.9%; p < 0.001). Pre-treatment (1 vs. 2 days; p < 0.001) and total ( 4 vs. 7 days; p < 0.001) LOS was lower in the USA. Overall incidence of bile duct injury was higher in England than the USA (0.83 vs. 0.43%; p < 0.001), but was no different following laparoscopic surgery (0.1%). In England, 40.5% of patients without an immediate cholecystectomy were subsequently readmitted with cholecystitis. An additional 14.5% were admitted for other biliary complications, amounting to 2.7 readmissions per patient in the year following primary admission.
This study highlights management practices for acute cholecystitis in the USA and England. Despite best evidence, index admission laparoscopic cholecystectomy is performed less in England, which significantly impacts subsequent healthcare utilization.
有证据表明，急性胆囊炎应尽早行腹腔镜胆囊切除术。但目前尚不清楚美国和英国之间在治疗模式上的差异、相关结局和资源利用情况。
本研究采用回顾性观察性研究，利用国家行政数据，在英格兰（1998-2012 年的医院就诊统计数据）和美国（1998-2011 年的国家住院患者样本）中确定了因急性胆囊炎而入院的急诊患者。比较了行急诊胆囊切除术、采用腹腔镜治疗的患者比例以及包括住院时间（LOS）和并发症在内的相关结局。还评估了英格兰患者延迟治疗对后续再入院的影响。
美国共有 1191331 例急性胆囊炎患者，英格兰有 288907 例。在此期间，美国共有 628395 例（52.7%）和英格兰有 45299 例（15.7%）患者行急诊胆囊切除术。美国腹腔镜手术更常见（82.8%比 37.9%；p<0.001）。美国患者的术前（1 天比 2 天；p<0.001）和总（4 天比 7 天；p<0.001）住院时间更短。英国的胆管损伤总发生率高于美国（0.83%比 0.43%；p<0.001），但腹腔镜手术后并无差异（0.1%）。在英格兰，40.5%未立即行胆囊切除术的患者随后因胆囊炎再次入院。另有 14.5%的患者因其他胆道并发症入院，导致在首次入院后的一年中每位患者有 2.7 次再入院。
本研究强调了美国和英国在急性胆囊炎管理方面的实践。尽管有最佳证据，但英国的指数入院腹腔镜胆囊切除术实施较少，这对后续的医疗保健利用产生了重大影响。
