School of Medicine, University of California San Francisco, San Francisco, CA, USA.
Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
Surg Endosc. 2024 Nov;38(11):6597-6604. doi: 10.1007/s00464-024-11224-9. Epub 2024 Sep 16.
Adults with cerebral palsy (CP) are a largely understudied, growing population with unique health care requirements. We sought to establish a deeper understanding of the surgical risk in adults with CP undergoing a common general surgical procedure: cholecystectomy.
Data were obtained from the State Inpatient Database developed for the Healthcare Cost and Utilization Project. Inclusion criteria included patients ≥ 18 years with CP and a primary ICD-9 procedure code indicating open or laparoscopic cholecystectomy. Demographics, procedure-related factors, and comorbid conditions were analyzed, and unplanned 30 and 90 day readmission rates calculated for each variable. Reasons for readmission based on ICD-9 diagnosis codes were grouped into relevant categories. Univariate analysis identified factors significantly associated with readmission rates.
A total of 802 patients with CP met the inclusion criteria. Unplanned 30 and 90 day readmission rates after laparoscopic cholecystectomy were 11.4% and 18.1%, respectively. Average length of stay (LOS) after laparoscopic cholecystectomy was 7.1 days. After open cholecystectomy, 30 and 90 day readmission rates were 16.9% and 30.3% with an average LOS of 14.6 days. Infection was the most common cause for 30 and 90 day readmission. Factors associated with 30 day readmission included type of cholecystectomy, LOS, discharge to skilled nursing facility, and comorbid diabetes and malnutrition. Factors associated with 90 day readmission included type of cholecystectomy, LOS, discharge to skilled nursing facility, and comorbid heart failure, renal disease, epilepsy, and malnutrition.
Unplanned readmission rates after open and laparoscopic cholecystectomy in adult patients with CP are much higher than previously demonstrated rates in the general population. These patients frequently suffer multiple comorbid conditions that significantly complicate their surgical care. As more and more of these patients live longer into adulthood, further study is warranted to grasp the perioperative risk of simple and complex surgical procedures.
脑瘫成年人（CP）是一个研究相对较少、人数不断增长的群体，他们有独特的医疗保健需求。我们试图更深入地了解 CP 成年人接受常见普外科手术（胆囊切除术）的手术风险。
数据来自为医疗保健成本和利用项目开发的国家住院患者数据库。纳入标准包括年龄≥18 岁的 CP 患者和指示开放性或腹腔镜胆囊切除术的主要 ICD-9 手术代码。分析了人口统计学、手术相关因素和合并症，并计算了每个变量的计划外 30 天和 90 天再入院率。根据 ICD-9 诊断代码将再入院原因分为相关类别。单变量分析确定了与再入院率显著相关的因素。
共有 802 名 CP 患者符合纳入标准。腹腔镜胆囊切除术后计划外 30 天和 90 天再入院率分别为 11.4%和 18.1%。腹腔镜胆囊切除术后平均住院时间（LOS）为 7.1 天。开腹胆囊切除术后 30 天和 90 天的再入院率分别为 16.9%和 30.3%，平均 LOS 为 14.6 天。感染是 30 天和 90 天再入院的最常见原因。与 30 天再入院相关的因素包括胆囊切除术类型、LOS、出院至熟练护理机构以及合并糖尿病和营养不良。与 90 天再入院相关的因素包括胆囊切除术类型、LOS、出院至熟练护理机构以及合并心力衰竭、肾脏疾病、癫痫和营养不良。
CP 成年患者行开放性和腹腔镜胆囊切除术的计划外再入院率远高于一般人群中先前报道的再入院率。这些患者经常患有多种合并症，这极大地增加了他们的手术治疗难度。随着越来越多的此类患者进入成年期，需要进一步研究以了解简单和复杂手术的围手术期风险。
