Department of Surgery, Letterkenny University Hospital, Donegal, Ireland.
Emergency Surgery Outcome Advancement Project, Donegal Clinical and Research Academy, Donegal, Ireland.
Anaesthesiol Intensive Ther. 2020;52(1):47-55. doi: 10.5114/ait.2020.92967.
Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgical procedures. Despite this, patterns of readmission following LC are not well defined. This meta-analysis aimed to determine rates and predictors of readmission.
An ethically approved International Prospective Register of Systematic Reviews (PROSPERO)-registered meta-analysis was undertaken searching PubMed, Scopus, Web of Science and Cochrane Library databases from January 2013-June 2018 adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Published literature potentially suitable for data analysis was graded using methodological index for non-randomised studies (MINORS) criteria; papers scoring ≥ 16/24 for comparative and ≥ 10/16 for non-comparative studies were included. A meta-analysis of potential risk factors was performed by computing the odds ratio using Mantel-Haenszel method and fixed-effects model with 95% confidence intervals.
Three thousand and eight hundred thirty-two articles were reduced to 44 studies qualifying for a final analysis of 1,573,715 laparoscopic cholecystectomies from 25 countries. Overall readmission rate was 3.3% (range: 0.0-11.7%); 52,628 readmissions out of 1,573,715 LCs. Surgical complications accounted for 76% of reported reasons for readmission, predominantly bile duct complications (33%), wound infection (17%) and nausea and vomiting (9%). Pain (15%) and cardiorespiratory complications (8%) account for the remainder. Obesity, single port LC and day case LC were not associated with increased rates.
Pain, nausea and vomiting and surgical complications, particularly bile duct obstruction are the most common causes for readmission. Intra-operative cholangiography may reduce readmission rates. Causes for readmission were inconsistently reported throughout. The mean readmission rate of 3.3% may act as a quality benchmark for improving LC, and clearer reporting of reasons for readmission are required to advance care.
腹腔镜胆囊切除术（LC）是最常进行的手术之一。尽管如此，LC 后的再入院模式仍未得到很好的定义。本荟萃分析旨在确定再入院的发生率和预测因素。
进行了一项符合系统评价和荟萃分析注册伦理标准（PROSPERO）的荟萃分析，从 2013 年 1 月至 2018 年 6 月，通过搜索 PubMed、Scopus、Web of Science 和 Cochrane Library 数据库，遵循系统评价和荟萃分析的首选报告项目（PRISMA）声明。使用非随机研究方法学指数（MINORS）标准对潜在适合数据分析的已发表文献进行分级；比较研究评分≥16/24，非比较研究评分≥10/16 的论文被纳入。使用 Mantel-Haenszel 方法和固定效应模型计算优势比（OR）进行潜在危险因素的荟萃分析，置信区间为 95%。
从 3832 篇文章中筛选出 44 篇符合最终分析的文章，分析了来自 25 个国家的 1573715 例腹腔镜胆囊切除术。总体再入院率为 3.3%（范围：0.0-11.7%）；1573715 例 LC 中有 52628 例再入院。手术并发症占报告再入院原因的 76%，主要为胆管并发症（33%）、伤口感染（17%）和恶心呕吐（9%）。疼痛（15%）和心肺并发症（8%）占其余部分。肥胖、单端口 LC 和日间 LC 与再入院率增加无关。
疼痛、恶心呕吐和手术并发症，特别是胆管梗阻是再入院的最常见原因。术中胆管造影术可能会降低再入院率。整个过程中再入院的原因报告不一致。3.3%的平均再入院率可能是提高 LC 质量的基准，需要更清楚地报告再入院的原因以改善治疗。
