Marco-Martínez Javier, Elola-Somoza Francisco Javier, Fernández-Pérez Cristina, Bernal-Sobrino José Luis, Azaña-Gómez Francisco Javier, García-Klepizg José Luis, Andrès Emmanuel, Zapatero-Gaviria Antonio, Barba-Martin Raquel, Calvo-Manuel Elpidio, Canora-Lebrato Jesus, Lorenzo-Villalba Noel, Méndez-Bailón Manuel
Internal Medicine Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos IdISSC, Universidad Complutense, 28040 Madrid, Spain.
Fundación Para la Mejora de la Asistencia Sanitaria, 28008 Madrid, Spain.
J Clin Med. 2021 Apr 16;10(8):1731. doi: 10.3390/jcm10081731.
The incidence of cholecystectomy is increasing as the result of the aging worldwide. Our aim was to determine the influence of heart failure on in-hospital outcomes in patients undergoing cholecystectomy in the Spanish National Health System (SNHS).
We conducted a retrospective study using the Spanish National Hospital Discharge Database. Patients older than 17 years undergoing cholecystectomy in the period 2007-2015 were included. Demographic and administrative variables related to patients' diseases as well as procedures were collected.
478,111 episodes of cholecystectomy were identified according to the data from SNHS hospitals in the period evaluated. From all the episodes, 3357 (0.7%) were excluded, as the result the sample was represented by 474,754 episodes. Mean age was 58.3 (+16.5) years, and 287,734 (60.5%) were women ( < 0.001). A primary or secondary diagnosis of HF was identified in 4244 (0.89%) ( < 0.001) and mean age was 76.5 (+9.6) years. A higher incidence of all main complications studied was observed in the HF group ( < 0.001), except stroke ( = 0.753). Unadjusted in-hospital mortality was 1.1%, 12.9% in the group with HF versus 1% in the non HF group ( < 0.001). Average length of hospital stay was 5.4 (+8.9) days, and was higher in patients with HF (16.2 + 17.7 vs. 5.3 + 8.8; < 0.001). Risk-adjusted in-hospital mortality models' discrimination was high in both cases, with AUROC values = 0.963 (0.960-0.965) in the APRG-DRG model and AUROC = 0.965 (0.962-0.968) in the CMS adapted model. Median odds ratio (MOR) was high (1.538 and 1.533, respectively), stating an important variability of risk-adjusted outcomes among hospitals.
The presence of HF during admission increases in hospital mortality and lengthens the hospital stay in patients undergoing cholecystectomy. However, mortality and hospital stay have significantly decreased during the study period in both groups (HF and non HF patients).
随着全球人口老龄化，胆囊切除术的发生率正在上升。我们的目的是确定心力衰竭对西班牙国家卫生系统（SNHS）中接受胆囊切除术患者住院结局的影响。
我们使用西班牙国家医院出院数据库进行了一项回顾性研究。纳入2007年至2015年期间年龄超过17岁且接受胆囊切除术的患者。收集了与患者疾病以及手术相关的人口统计学和管理变量。
根据评估期间SNHS医院的数据，共识别出478,111例胆囊切除术病例。在所有病例中，3357例（0.7%）被排除，最终样本为474,754例。平均年龄为58.3（±16.5）岁，女性有287,734例（60.5%）（P<0.001）。4244例（0.89%）患者被确诊为原发性或继发性心力衰竭（P<0.001），平均年龄为76.5（±9.6）岁。心力衰竭组中所有研究的主要并发症发生率均较高（P<0.001），但中风除外（P = 0.753）。未调整的住院死亡率为1.1%，心力衰竭组为12.9%，非心力衰竭组为1%（P<0.001）。平均住院时间为5.4（±8.9）天，心力衰竭患者的住院时间更长（16.2±17.7天对5.3±8.8天；P<0.001）。风险调整后的住院死亡率模型在两种情况下的区分度都很高，APRG-DRG模型的AUROC值为0.963（0.960 - 0.965），CMS适配模型的AUROC值为0.965（0.962 - 0.968）。中位数优势比（MOR）较高（分别为1.538和1.533），表明各医院之间风险调整后的结局存在重要差异。
入院时存在心力衰竭会增加接受胆囊切除术患者的住院死亡率并延长住院时间。然而，在研究期间，两组（心力衰竭患者和非心力衰竭患者）的死亡率和住院时间均显著下降。
