Noubani Mohammad, Sethi Ila, McCarthy Elizabeth, Stanley Samuel L, Zhang Xiaoyue, Yang Jie, Spaniolas Konstantinos, Pryor Aurora D
Department of Surgery, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27517, USA.
Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA.
Surg Endosc. 2023 Dec;37(12):9132-9138. doi: 10.1007/s00464-023-10451-w. Epub 2023 Oct 9.
This study aims to explore how timing of interval of cholecystectomy (IC) after percutaneous transhepatic cholecystostomy tube (PTC) placement impacts post-operative outcomes.
A retrospective database analysis of New York State SPARCs database of IC between 2005 and 2015. The timing for IC ranged between > 1 week and < 2 years. Patients undergoing this procedure were further divided into quartiles using 4-time intervals; 1-5 weeks (Q1), 5-8 weeks (Q2), 8-12 weeks(Q3), and > 12 weeks(Q4). The study's primary outcome was hospital length of stay (LOS). Secondary outcomes included discharge status, 30-day readmission, 30-day ED visit, and 90-day reoperation, surgery type, complication, and bile duct injury. Multivariable regression models were used to compare patients across the four-time intervals after adjusting for confounding factors.
A total of 1038 patients with a history of PTC followed by IC between > 1 week and < 2 years were included in the final analysis. The median time to IC was 7.7 weeks. Q2 and Q3 both had a significantly higher median LOS of 3 days versus Q1 and Q4 at median of 5 days (p < 0.0001). Patients from racial and ethnic minorities (e.g., African Americans and Hispanics) were more likely to get their IC after 12 weeks (p < 0.05). Further, Black patients had a significantly higher median LOS than White, non-Hispanic patients (8 days vs 4 days, p < 0.0001) and were more likely to have open procedure. Multivariable regression analysis identified shorter LOS during Q2 (Ratio, 0.76, 95%, 0.67-0.87, p < 0.0001), and Q3 (Ratio 0.75, 95% CI, 065-0.86, p < 0.0001) compared to those who got their IC in Q4. Similar findings exist when comparing Q2 and Q3 to those receiving treatment during Q1.
A time interval of 5-12 weeks between PTC and IC was associated with a decreased LOS. This study also suggests the persistence of racial disparities among these patients.
本研究旨在探讨经皮经肝胆管引流管（PTC）置入后胆囊切除术（IC）的时间间隔如何影响术后结局。
对纽约州2005年至2015年期间IC的SPARCs数据库进行回顾性分析。IC的时间间隔在1周以上至2年以下。接受该手术的患者根据4个时间间隔进一步分为四分位数；1 - 5周（Q1）、5 - 8周（Q2）、8 - 12周（Q3）和12周以上（Q4）。该研究的主要结局是住院时间（LOS）。次要结局包括出院状态、30天再入院、30天急诊就诊、90天再次手术、手术类型、并发症和胆管损伤。在调整混杂因素后，使用多变量回归模型对四个时间间隔的患者进行比较。
共有1038例有PTC病史且随后进行IC的患者纳入最终分析，IC的中位时间为7.7周。Q2和Q3的中位LOS均显著高于Q1和Q4，分别为3天和5天（p < 0.0001）。少数族裔（如非裔美国人和西班牙裔）患者更有可能在12周后进行IC（p < 0.05）。此外，黑人患者的中位LOS显著高于非西班牙裔白人患者（8天对4天，p < 0.0001），且更有可能接受开放手术。多变量回归分析发现，与在Q4进行IC的患者相比，Q2（比值，0.76，95%，0.67 - 0.87，p < 0.0001）和Q3（比值0.75，95% CI，0.65 - 0.86，p < 0.0001）的LOS更短。将Q2和Q3与在Q1接受治疗的患者进行比较时也有类似发现。
PTC与IC之间5 - 12周的时间间隔与LOS缩短相关。本研究还表明这些患者中种族差异仍然存在。
