Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA.
Surg Endosc. 2019 Oct;33(10):3396-3403. doi: 10.1007/s00464-018-06634-5. Epub 2019 Jan 2.
While cholecystectomy (CCY) is the standard of care for gallstone-related acute cholecystitis, percutaneous cholecystostomy-tube (CCYT-tube) is an alternative option in patients with significant comorbid conditions. We sought to identify immediate and longitudinal hospital outcomes of patients who underwent CCYT-tube placement and determine predictors of CCYT-tube placement and eventual CCY on a national level in the US.
We identified all adults (age ≥ 18 years) with a primary diagnosis of acute calculous cholecystitis from January to November 2013 in the Nationwide Readmissions Database (NRD). The NRD allows longitudinal follow-up of a patient for one calendar year. Outcomes of patients undergoing CCY and CCYT-tube were compared. Separate univariable and multivariable regression analyses were performed to identify predictors of CCYT-tube placement and failure to undergo subsequent CCY.
A total of 181,262 patients had an index hospitalization with acute cholecystitis where 178,095 (98.3%) patients underwent only CCY and 3167 (1.7%) patients were managed with CCYT-tubes. Among patients with CCYT-tube, 1196 (37.8%) underwent eventual CCY in 2013, while 1971 (62.2%) did not. One in five patients with CCYT-tube were readmitted within 30 days of hospital discharge. Multivariable analysis demonstrated that increasing age, male gender, coronary artery disease, cirrhosis, atrial fibrillation, diastolic congestive heart failure, and sepsis were associated with CCYT-tube placement. Longitudinal follow-up revealed that older age (OR 1.16, 95% CI 1.09-1.23), Elixhauser comorbidity score 3-4 (OR 1.94, 95% CI 1.03-3.63), cirrhosis (OR 3.28, 95% CI 1.59-6.79), and diastolic congestive heart failure (OR 2.47, 95% CI 1.33-4.60) were associated with failure to undergo subsequent CCY.
In this national survey, nearly two in three patients who receive CCYT-tube for acute cholecystitis do not get CCY during longitudinal data capture within the same calendar year. Future research needs to target novel options for drainage of the gallbladder in high-risk patient populations.
虽然胆囊切除术（CCY）是治疗胆石相关急性胆囊炎的标准治疗方法，但在患有严重合并症的患者中，经皮胆囊造瘘管（CCYT 管）是一种替代选择。我们旨在确定在美国全国范围内接受 CCYT 管放置的患者的即刻和纵向医院结局，并确定 CCYT 管放置和最终 CCY 的预测因素。
我们从 2013 年 1 月至 11 月在全国再入院数据库（NRD）中确定了所有年龄≥18 岁的急性结石性胆囊炎的成年人（年龄≥18 岁）。NRD 允许对患者进行长达一年的纵向随访。比较了接受 CCY 和 CCYT 管的患者的结局。分别进行单变量和多变量回归分析，以确定 CCYT 管放置和未能随后进行 CCY 的预测因素。
共有 181262 名患者因急性胆囊炎接受了指数住院治疗，其中 178095 名（98.3%）患者仅接受了 CCY 治疗，3167 名（1.7%）患者接受了 CCYT 管治疗。在接受 CCYT 管的患者中，有 1196 名（37.8%）在 2013 年最终接受了 CCY，而 1971 名（62.2%）没有。接受 CCYT 管的患者中有五分之一在出院后 30 天内再次入院。多变量分析表明，年龄增长、男性、冠状动脉疾病、肝硬化、心房颤动、舒张性充血性心力衰竭和败血症与 CCYT 管放置相关。纵向随访显示，年龄较大（OR 1.16，95%CI 1.09-1.23）、Elixhauser 合并症评分 3-4（OR 1.94，95%CI 1.03-3.63）、肝硬化（OR 3.28，95%CI 1.59-6.79）和舒张性充血性心力衰竭（OR 2.47，95%CI 1.33-4.60）与未能随后进行 CCY 相关。
在这项全国性调查中，近三分之二接受 CCYT 管治疗急性胆囊炎的患者在同一年的纵向数据采集期间未接受 CCY。未来的研究需要针对高危人群的胆囊引流的新选择。
