Department of General Surgery, NHS Grampian, Aberdeen, UK.
HPB Surgery Unit, Integrated Centres of Excellence, Elite Healthcare, Alexandria, Egypt.
BJS Open. 2023 Jul 3;7(4). doi: 10.1093/bjsopen/zrad073.
Acute cholecystitis is one of the most common diagnoses presenting to emergency general surgery and is managed either operatively or conservatively. However, operative rates vary widely across the world. This real-world population analysis aimed to describe the current clinical management and outcomes of patients with acute cholecystitis across Scotland, UK.
This was a national cohort study using data obtained from Information Services Division, Scotland. All adult patients with the admission diagnostic code for acute cholecystitis were included. Data were used to identify all patients admitted to Scottish hospitals between 1997 and 2019 and outcomes tracked for inpatients or after discharge through the unique patient identifier. This was linked to death data, including date of death.
A total of 47 558 patients were diagnosed with 58 824 episodes of acute cholecystitis (with 27.2 per cent of patients experiencing more than one episode) in 46 Scottish hospitals. Median age was 58 years (interquartile range (i.q.r.) 43-71), 64.4 per cent were female, and most (76.1 per cent) had no comorbidities. A total of 28 741 (60.4 per cent) patients had an operative intervention during the index admission. Patients who had an operation during their index admission had a lower risk of 90-day mortality compared with non-operative management (OR 0.62, 95% c.i. 0.55-0.70).
In this study, 60 per cent of patients had an index cholecystectomy. Patients who underwent surgery had a better survival rate compared with those managed conservatively, further advocating for an operative approach in this cohort.
急性胆囊炎是急诊普通外科最常见的诊断之一，其治疗方法为手术或保守治疗。然而，世界各地的手术率差异很大。本项真实世界人群分析旨在描述英国苏格兰地区急性胆囊炎患者的当前临床管理和结局。
这是一项全国性队列研究，使用苏格兰信息服务司获得的数据。所有符合急性胆囊炎入院诊断代码的成年患者均被纳入研究。数据用于识别 1997 年至 2019 年期间苏格兰各医院收治的所有患者，并通过唯一的患者识别码跟踪住院患者或出院后的结局。这与死亡数据相关联，包括死亡日期。
共有 47558 名患者被诊断为 58824 例急性胆囊炎发作（其中 27.2%的患者经历了不止一次发作），涉及苏格兰 46 家医院。患者中位年龄为 58 岁（四分位间距（IQR）为 43-71 岁），64.4%为女性，大多数（76.1%）无合并症。共有 28741 名（60.4%）患者在指数入院期间接受了手术干预。与非手术治疗相比，在指数入院期间接受手术的患者 90 天死亡率风险较低（比值比（OR）0.62，95%置信区间（c.i.）0.55-0.70）。
在本研究中，60%的患者接受了指数胆囊切除术。与保守治疗相比，接受手术的患者存活率更高，进一步支持对该队列采取手术治疗。
