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在急性护理手术环境中,术前等待时间会影响接受腹腔镜胆囊切除术患者的住院时间。

Preoperative Waiting Time Affects the Length of Stay of Patients Treated via Laparoscopic Cholecystectomy in an Acute Care Surgical Setting.

作者信息

Bressan Livia, Cimino Matteo Maria, Vaccari Federica, Capozzela Eugenia, Biloslavo Alan, Porta Matteo, Bortul Marina, Kurihara Hayato

机构信息

Department of Emergency Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy.

Department of General Surgery, Cattinara University Hospital, Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), Trieste University, Strada di Fiume 447, 34149 Trieste, Italy.

出版信息

J Clin Med. 2024 Nov 29;13(23):7263. doi: 10.3390/jcm13237263.

Abstract

Acute cholecystitis (AC) presents a significant burden in emergency surgical settings. Early laparoscopic cholecystectomy (ELC) is the standard of care for AC, yet its implementation varies. This study aims to assess the impact of preoperative waiting time (WT) on postoperative length of stay (LOS) in patients undergoing urgent cholecystectomy. From June 2021 to September 2022, data on patients undergoing urgent cholecystectomy for AC or pancreatitis were collected from two university hospitals. Patients were categorized into early (ELC) or delayed (DLC) cholecystectomy groups based on WT. The primary outcome was the assessment of the variables influencing LOS via univariate and multivariate analyses. This study included 170 patients, predominantly female, with a median age of 64.50 years. ELC was performed in 58.2% of cases, with a median WT of 0 days, while DLC was performed in 41.8%, with a median WT of 3 days. Postoperative complications occurred in 21.8% of cases, with LOS being significantly shorter in the ELC group (median 5 days vs. 9 days; = 0.001). Multivariate analysis confirmed that WT (OR 8.08 (1.65-77.18; = 0.033)) was the most important predictor of LOS. ELC is associated with a shorter LOS and with DLC, aligning with the WSES recommendations. Earlier surgery reduces the risk of complications and overall hospital costs. An extended WT contributes to a prolonged LOS, underscoring the importance of timely access to operating theaters for acute biliary pathologies.

摘要

急性胆囊炎(AC)在急诊手术环境中带来了重大负担。早期腹腔镜胆囊切除术(ELC)是AC的标准治疗方法,但其实施情况各不相同。本研究旨在评估术前等待时间(WT)对接受紧急胆囊切除术患者术后住院时间(LOS)的影响。2021年6月至2022年9月,从两家大学医院收集了因AC或胰腺炎接受紧急胆囊切除术患者的数据。根据WT将患者分为早期(ELC)或延迟(DLC)胆囊切除术组。主要结果是通过单因素和多因素分析评估影响LOS的变量。本研究纳入了170例患者,以女性为主,中位年龄为64.50岁。58.2%的病例进行了ELC,中位WT为0天,而41.8%的病例进行了DLC,中位WT为3天。21.8%的病例发生了术后并发症,ELC组的LOS明显更短(中位5天对9天;P = 0.001)。多因素分析证实,WT(OR 8.08(1.65 - 77.18;P = 0.033))是LOS的最重要预测因素。ELC与较短的LOS相关,与DLC相比,符合WSES的建议。早期手术可降低并发症风险和总体医院成本。延长的WT会导致LOS延长,强调了及时进入手术室治疗急性胆道疾病的重要性。

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Prediction of difficult laparoscopic cholecystectomy: An observational study.困难腹腔镜胆囊切除术的预测:一项观察性研究。
Ann Med Surg (Lond). 2021 Nov 14;72:103060. doi: 10.1016/j.amsu.2021.103060. eCollection 2021 Dec.

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