Chervu Nikhil L, Vadlakonda Amulya, Ascandar Nameer, Kronen Elsa, Bakhtiyar Syed Shahyan, Cho Nam Yong, Benharash Peyman
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Depatment of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Am Surg. 2023 Oct;89(10):4013-4017. doi: 10.1177/00031348231175145. Epub 2023 May 9.
An increasing body of literature supports subtotal cholecystectomy (STC) in the management of patients with difficult gallbladder anatomy; however, large-scale studies examining outcomes of total cholecystectomy and STC are lacking.
All adults undergoing total cholecystectomy or STC were tabulated from the 2016-2019 Nationwide Readmissions Database. Entropy balancing was performed to adjust for patient differences based on extent of resection. Subsequent multivariable regression models were used to assess the association of STC with major adverse events, postoperative length of stay (pLOS), hospitalization costs, and 30-day non-elective readmission rates.
Of an estimated 854 357 patients, 7089 (.8%) underwent STC. Compared to total, STC patients were significantly older, less commonly female, and had a higher Elixhauser Index (all < .001). Both cohorts had similar rates of postoperative ERCP (1.7% vs 1.5%, = .33); however, the STC cohort had significantly higher utilization of subsequent drainage procedures (1.8% vs .5%, < .001). After entropy balancing and multivariable risk-adjustment, STC was not associated with greater odds of MAE (AOR 1.11, 95% CI .99-1.23, = .06). Notably, relative to total, STC was associated with longer pLOS ( .14, 95% CI .11-.17, < .001) and greater hospitalization costs (β + $1,900, 95% CI 1300-2,500, < .001). However, the extent of resection was not associated with the likelihood of 30-day non-elective readmission (AOR 1.01, 95% CI .91-1.13, = .86).
Our findings suggest that STC is a viable, yet resource intensive, option in the management of complex cholecystitis.
越来越多的文献支持在胆囊解剖结构复杂的患者管理中采用胆囊次全切除术（STC）；然而，缺乏对胆囊全切除术和STC结局进行的大规模研究。
从2016 - 2019年全国再入院数据库中列出所有接受胆囊全切除术或STC的成年人。进行熵平衡以根据切除范围调整患者差异。随后使用多变量回归模型评估STC与主要不良事件、术后住院时间（pLOS）、住院费用和30天非择期再入院率之间的关联。
在估计的854357例患者中，7089例（0.8%）接受了STC。与胆囊全切除术患者相比，STC患者年龄显著更大，女性比例更低，且埃利克斯豪泽指数更高（均P < 0.001）。两个队列的术后内镜逆行胰胆管造影（ERCP）发生率相似（1.7%对1.5%，P = 0.33）；然而，STC队列后续引流操作的使用率显著更高（1.8%对0.5%，P < 0.001）。经过熵平衡和多变量风险调整后，STC与主要不良事件的更高发生率无关（调整后比值比[AOR]为1.11，95%置信区间[CI]为0.99 - 1.23，P = 0.06）。值得注意的是，相对于胆囊全切除术，STC与更长的pLOS相关（β为0.14，95% CI为0.11 - 0.17，P < 0.001）以及更高的住院费用（β增加1900美元，95% CI为1300 - 2500美元，P < 0.001）。然而，切除范围与30天非择期再入院的可能性无关（AOR为1.01，95% CI为 .91 - 1.13，P = 0.86）。
我们的研究结果表明，STC是治疗复杂性胆囊炎的一种可行但资源密集型的选择。
