Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza MS390, Houston, TX, USA.
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza MS390, Houston, TX, USA.
Am J Surg. 2019 Dec;218(6):1084-1089. doi: 10.1016/j.amjsurg.2019.08.008. Epub 2019 Aug 19.
Current guidelines fail to specify optimal timing of early cholecystectomy for acute cholecystitis. We hypothesized delaying operation past hospital day (HD) 2 would result in increased 30-day morbidity and mortality.
The ACS-NSQIP database was queried from 2012 to 2015 for all cholecystectomies for acute cholecystitis from HD 1-7.
Delay in cholecystectomy to HD 3-7 was observed in 30% of patients with acute cholecystitis. Patients undergoing operation on HD 3-7 were older with higher rates of comorbidities (median 58yrs; 66%) than HD 1 (48yrs; 51%) or HD 2 (51yrs, p < 0.001; 55%, p < 0.001). Operations on HD 3-7 had increased 30-day mortality (1.0%) and morbidity (12%) in comparison to HD 1 (0.3%, 7%) or HD 2 (0.5%, p < 0.001; 8%, p < 0.001). On multivariable analysis, HD was an independent predictor of mortality (OR 1.15, 95% CI [1.04-1.26]).
Acute cholecystitis should be treated with an urgent operation within 2 days of admission due to increased morbidity and mortality when delayed past HD 2.
目前的指南未能明确指出急性胆囊炎早期胆囊切除术的最佳时机。我们假设将手术推迟到住院后第 2 天以上会导致 30 天内发病率和死亡率增加。
从 2012 年到 2015 年，ACS-NSQIP 数据库对从住院第 1 天到第 7 天因急性胆囊炎而行胆囊切除术的所有患者进行了查询。
30%的急性胆囊炎患者会延迟到住院后第 3-7 天进行胆囊切除术。与住院第 1 天（48 岁；51%）或第 2 天（51 岁，p<0.001；55%）相比，住院第 3-7 天接受手术的患者年龄更大，合并症发生率更高（中位数 58 岁；66%）（p<0.001）。与住院第 1 天（0.3%，7%）或第 2 天（0.5%，p<0.001；8%）相比，住院第 3-7 天的手术会增加 30 天死亡率（1.0%）和发病率（12%）。多变量分析显示，住院天数是死亡率的独立预测因素（OR 1.15，95%CI[1.04-1.26]）。
由于住院第 2 天以后手术会增加发病率和死亡率，因此急性胆囊炎应在入院后 2 天内进行紧急手术。
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