急诊腹腔镜胆囊切除术路径可减少择期等待时间和术前住院时间：一项前瞻性倾向匹配队列研究。
Emergency Laparoscopic Cholecystectomy Pathway Reduces Elective Waiting Times and Preoperative Admissions: A Prospective Propensity-Matched Cohort Study.
作者信息
Hamid Mohammed, Mostafa Omar E S, Kausar Maria, Amin Amina, Olajumoke Oladapo, Singhal Abhinav, Bharnala Gowtham, Akingboye Akinfemi, Camprodon Ricardo, Sellahewa Chaminda
机构信息
General Surgery Department, Russell's Hall Hospital, Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley DY1 2HQ, UK.
Aston Medical School, College of Health and Life Science, Aston University, Birmingham B4 7ET, UK.
出版信息
Med Sci (Basel). 2025 Jun 27;13(3):86. doi: 10.3390/medsci13030086.
BACKGROUND
Emergency laparoscopic cholecystectomy (ELC) has emerged as a viable alternative to delayed elective surgery for acute gallstone disease, although its widespread adoption is hindered by cultural barriers. This study compares outcomes between elective and emergency laparoscopic cholecystectomy and evaluates the impact of implementing an ELC pathway on elective waiting times, patient outcomes, and overall service delivery.
METHODS
A prospective cohort study was conducted between December 2021 and December 2023, including all patients undergoing emergency or elective laparoscopic cholecystectomy. One-to-one propensity score matching, correlation statistics, and multivariate logistic regression were used to analyse outcomes.
RESULTS
Of 585 patients, 314 (53.4%) underwent emergency and 271 (46.3%) elective cholecystectomies. After matching, 474 patients were analysed (237 per group). The ELC pathway achieved an 81.4% first-presentation procedure rate, with 69.2% managed as day cases and 84.4% discharged the following day. Emergency cases had longer operative times (+9 min), higher rates of subtotal cholecystectomy (8.9% vs. 3.0%, < 0.001), and more frequent postoperative ERCP (16.9% vs. 4.6%, < 0.001). Other outcomes were comparable. Introduction of the ELC pathway significantly reduced elective waiting times from a median of nine to three months (R = -0.219, R = 0.059, < 0.001) and preoperative admissions (IQR 0-1, R = -0.223, R = 0.050, = 0.002).
CONCLUSIONS
An ELC pathway is a safe and effective alternative to elective gallstone surgery, offering substantial benefits to patients and healthcare systems, while serving as a strategic, cost-conscious approach to reducing surgical waiting times and preoperative admissions. Its success hinges upon surgical expertise in acute decision making, skill in performing subtotal cholecystectomy, and access to institutional resources such as advanced imaging and ERCP services.
背景
急诊腹腔镜胆囊切除术（ELC）已成为急性胆石症延迟择期手术的一种可行替代方案，尽管其广泛应用受到文化障碍的阻碍。本研究比较了择期和急诊腹腔镜胆囊切除术的结果，并评估了实施ELC路径对择期等待时间、患者结局和整体服务提供的影响。
方法
在2021年12月至2023年12月期间进行了一项前瞻性队列研究，纳入了所有接受急诊或择期腹腔镜胆囊切除术的患者。采用一对一倾向评分匹配、相关性统计和多因素逻辑回归分析结果。
结果
585例患者中，314例（53.4%）接受了急诊胆囊切除术，271例（46.3%）接受了择期胆囊切除术。匹配后，分析了474例患者（每组237例）。ELC路径实现了81.4%的首次就诊手术率，69.2%作为日间手术处理，84.4%在次日出院。急诊病例的手术时间更长（+9分钟），胆囊次全切除术的发生率更高（8.9%对3.0%，<0.001），术后ERCP更频繁（16.9%对4.6%，<0.001）。其他结果相当。ELC路径的引入显著缩短了择期等待时间，从中位数9个月缩短至3个月（R=-0.219，R=0.059，<0.001），并减少了术前住院次数（IQR 0-1，R=-0.223，R=0.050，=0.002）。
结论
ELC路径是择期胆石症手术的一种安全有效的替代方案，为患者和医疗系统带来了巨大益处，同时也是一种减少手术等待时间和术前住院次数的战略、注重成本的方法。其成功取决于急性决策中的手术专业知识、胆囊次全切除术的操作技能以及获得先进影像学和ERCP服务等机构资源。
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