Johnson Patrick L, Williams Jonathan E, Schaefer Sara L, Gerhardinger Laura, Lindsey Hugh J, Pesta Carl, Yang Amanda, Hunter Mary A, Griggs Jennifer J, Hemmila Mark R
Department of Surgery, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI.
Department of Surgery, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI.
Surgery. 2025 Mar;179:108842. doi: 10.1016/j.surg.2024.07.078. Epub 2024 Oct 11.
Patients undergoing active cancer therapy or with metastatic cancer are at increased risk for acute cholecystitis and often present to general surgeons for evaluation and management. There is a paucity of data regarding the treatment processes used in these patients and the clinical outcomes achieved. Optimal management of acute cholecystitis in patients with cancer requires understanding their unique risk profile and options for treatment.
Emergency general surgery data were collected at 10 hospitals from July 1, 2019, to February 29, 2024. Patients presenting with acute cholecystitis were selected for analysis. Propensity score matching was used to create matched cohorts of patients by the presence or absence of an active malignancy. The primary outcome was 30-day mortality. Secondary outcomes included complications, length of stay, readmission, and discharge disposition. Processes investigated include treatment modality, time to operation, and surgical technique.
The analysis included 8,673 patients. Mean age was 53.2 ± 19 years, 61.4% were female, and 17.8% were non-White. In total, 3.3% of patients had an active malignancy. Risk-adjusted 30-day mortality was higher in the cancer cohort (odds ratio: 5.85, 95% confidence interval: 2.38-14.4, P < .001). Patients with cancer also had higher rates of infectious complications (odds ratio: 2.55, 95% confidence interval: 1.54-4.2, P < .001), including sepsis (odds ratio: 2.95, 95% confidence interval: 1.61-5.39, P < .001) and pneumonia (odds ratio: 6.67, 95% confidence interval: 1.75-25.3, P < .005). Patients with cancer were more likely to receive nonoperative management (odds ratio: 2.85, 95% confidence interval: 2.11-3.84, P < .001).
Patients with cancer presenting with acute cholecystitis experience worse clinical outcomes after controlling for other factors. Furthermore, there is variation in the treatment process with increased rates of nonoperative management. These results have implications for the management of this population, particularly in relation to the impact on concurrent oncologic treatment plans.
正在接受积极癌症治疗或患有转移性癌症的患者发生急性胆囊炎的风险增加，并且经常到普通外科医生处进行评估和治疗。关于这些患者所采用的治疗过程及所取得的临床结果的数据匮乏。癌症患者急性胆囊炎的最佳治疗需要了解其独特的风险特征和治疗选择。
收集了2019年7月1日至2024年2月29日期间10家医院的急诊普通外科数据。选择出现急性胆囊炎的患者进行分析。采用倾向评分匹配法，根据是否存在活动性恶性肿瘤创建匹配的患者队列。主要结局是30天死亡率。次要结局包括并发症、住院时间、再入院率和出院处置情况。所调查的过程包括治疗方式、手术时间和手术技术。
分析纳入8673例患者。平均年龄为53.2±19岁，61.4%为女性，17.8%为非白人。总体而言，3.3%的患者患有活动性恶性肿瘤。癌症队列中经风险调整的30天死亡率更高（比值比：5.85，95%置信区间：2.38 - 14.4，P <.001）。癌症患者的感染性并发症发生率也更高（比值比：2.55，95%置信区间：1.54 - 4.2，P <.001），包括脓毒症（比值比：2.95，95%置信区间：1.61 - 5.39，P <.001）和肺炎（比值比：6.67，95%置信区间：1.75 - 25.3，P <.005）。癌症患者更有可能接受非手术治疗（比值比：2.85，95%置信区间：2.11 - 3.84，P <.001）。
患有急性胆囊炎的癌症患者在控制其他因素后临床结局更差。此外，治疗过程存在差异，非手术治疗率增加。这些结果对该人群的治疗具有启示意义，特别是在对同时进行的肿瘤治疗计划的影响方面。
