Kennedy C, Gaw F, Brown C, Taylor E
Department of Surgery, Kern Medical Center, Bakersfield, CA 93305, USA.
Am Surg. 1995 Oct;61(10):865-7.
A total of 215 cholecystectomies were performed at Kern Medical Center over a 20-month period from 10/92 to 5/94 and were retrospectively reviewed. Twenty-four males and 191 females ranged in age from 15-70 years. Of the total 215 cholecystectomies, 119 were performed electively and were separated into two groups. Group 1 (79) consisted of patients awaiting state authorization for cholecystectomy. Group 2 (40) consisted of patients who did not require state authorization. Date of diagnosis was defined as the date when the positive gallbladder ultrasound was completed which, in context with the clinical presentation, confirmed the need for cholecystectomy. The average number of days between diagnosis and cholecystectomy differed significantly between Group 1 and 2 (116 vs 23 respectively, P < .01). The average number of preoperative emergency room (ER) visits differed significantly between Group 1 and 2 (1.48 vs 0.76 respectively, P < .01). The average number of preoperative surgery clinic visits also differed between the two groups (2.88 vs 1.96 in Group 1 and 2 respectively, P < .01). Patients with symptomatic cholelithiasis requiring state approval for cholecystectomy had to wait longer for their operation, and preoperatively visited the ER and outpatient surgery clinic more often. Delay increases patient discomfort and adds additional strain to an already overcrowded ER and clinic. Finally, the economic impact is most likely significant as lost work hours, and additional ER and clinic visits cost taxpayers money.
在1992年10月至1994年5月的20个月期间，克恩医疗中心共进行了215例胆囊切除术，并进行了回顾性研究。其中男性24例，女性191例，年龄在15至70岁之间。在总共215例胆囊切除术中，119例为择期手术，并分为两组。第一组（79例）由等待国家批准胆囊切除术的患者组成。第二组（40例）由不需要国家批准的患者组成。诊断日期定义为胆囊超声检查结果为阳性的日期，结合临床表现，该结果证实了进行胆囊切除术的必要性。第一组和第二组在诊断至胆囊切除术之间的平均天数差异显著（分别为116天和23天，P < 0.01）。第一组和第二组术前急诊室（ER）就诊的平均次数差异显著（分别为1.48次和0.76次，P < 0.01）。两组术前外科门诊就诊的平均次数也有所不同（第一组和第二组分别为2.88次和1.96次，P < 0.01）。需要国家批准胆囊切除术的症状性胆石症患者必须等待更长时间才能进行手术，并且术前更频繁地前往急诊室和门诊外科就诊。延迟会增加患者的不适，并给本已人满为患的急诊室和诊所带来额外压力。最后，经济影响很可能是巨大的，因为工作时间的损失以及额外的急诊室和门诊就诊会让纳税人付出代价。
