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| 1 | Operative complications and economic outcomes of cholecystectomy for acute cholecystitis显示文摘BACKGROUND Recent management of acute cholecystitis favors same admission(SA)or emergent cholecystectomy based on overall shorter hospital stay and therefore cost savings.We adopted the practice of SA cholecystectomy for the treatment of acute cholecystitis at our tertiary care center and wanted to evaluate the economic benefit of this practice.We hypothesized that the existence of complications,particularly among patients with a higher degree of disease severity,during SA cholecystectomy could negate the cost savings.AIM To compare complication rates and hospital costs between SA vs delayed cholecystectomy among patients admitted emergently for acute cholecystitis.METHODS Under an IRB-approved protocol,complications and charges for were obtained for SA,later after conservative management(Delayed),or elective cholecystectomies over an 8.5-year period.Patients were identified using the acute care surgery registry and billing database.Data was retrieved via EMR,operative logs,and Revenue Cycle Operations.The severity of acute cholecystitis was graded according to the Tokyo Guidelines.TG18 categorizes acute cholecystitis by Grades 1,2,and 3 representing mild,moderate,and severe,respectively.Comparisons were analyzed withχ2,Fisher’s exact test,ANOVA,ttests,and logistic regression;significance was set at P<0.05.RESULTS Four hundred eighty-six(87.7%)underwent a SA while 68 patients(12.3%)received Delayed cholecystectomy.Complication rates were increased after SA compared to Delayed cholecystectomy(18.5%vs 4.4%,P=0.004).The complication rates of patients undergoing delayed cholecystectomy was similar to the rate for elective cholecystectomy(7.4%,P=0.35).Mortality rates were 0.6%vs 0%for SA vs Delayed.Patients with moderate disease(Tokyo 2)suffered more complications among SA while none who were delayed experienced a complication(16.1%vs 0.0%,P<0.001).Total hospital charges for SA cholecystectomy were increased compared to a Delayed approach($44500±$59000 vs$35300±$16700,P=0.019).The relative risk of developing a complication was 4.2x[95%confidence interval(CI):1.4-12.9]in the SA vs Delayed groups.Among eight patients(95%CI:5.0-12.3)with acute cholecystitis undergoing SA cholecystectomy,one patient will suffer a complication.CONCLUSION Patients with Tokyo Grade 2 acute cholecystitis had more complications and increased hospital charges when undergoing SA cholecystectomy.This data supports a selective approach to SA cholecystectomy for acute cholecystitis. | Christopher P Rice Krishnamurthy B Vaishnavi Celia Chao Daniel Jupiter August B Schaeffer Whitney R Jenson Lance W Griffin William J Mileski | 2019 | World Journal of Gastroenterology2019，25，48： | 8 |
| 2 | Localization of appendix with MDCT and influence of findings on choice of appendectomy incision 显示文摘 | Oto A Ernst RD Mileski WJ | 2006 | A JR2006，187，4： | 1 |
| 3 | Early assessment of pediat-ric bum wounds by laser Doppler flow metry 显示文摘 | Atiles L Mileski W Spann K | 1995 | J Burn CareRehabil1995，16，3： | 1 |
| 4 | Localization of appendix with MD- CT and influence of findings on choice of appendectany incision显示文摘 | Oto A Emst RD Mileski WJ | 2006 | AJR2006，187，4： | 1 |
| 5 | Alteration in Resistin Expression After Thermal Injury显示文摘 | Dasu MR Lagrone L Mileski WJ | 2004 | J Trauma2004，56，1： | 1 |
| 6 | Alterations in Resistin Expression After Thermal Injury显示文摘 | Dasu MR LaGrone L Mileski WJ | 2004 | J Trauma2004，56，1： | 1 |
| 7 | The use of abdominal computed tomography scan decreases the fre- quency of misdiagnosis in cases of suspected appendicitis 显示文摘 | Naoum J J Mileski W J Daller J A | 2002 | Am J Surg2002，184，6： | 1 |
| 8 | Alterations in resistin expression after thermal injury 显示文摘 | Dasu MR LaGrone L Mileski WJ | 2004 | J Trauma2004，56，1： | 1 |
| 9 | Localization of Appendix with MDCT and Influence of Findings on Choice of Appendectomy Incision显示文摘 | Oto A Ernst RD Mileski WJ | 2006 | AJR2006，187，4： | 1 |
| 10 | Alterations in leukocyte adhesion molecule expression after burn injury 显示文摘 | Nwariaku FE Mileski W J Lightfoot E | 1995 | Trauma1995，39，： | 1 |
| 11 | Inhibition of CD18-dependent neutrophil adherenece reduces organ injury after hemorrhagic shock im primates 显示文摘 | Winn RK Vedder NB | 1990 | Surgery1990，108，1： | 1 |
| 12 | The contribution of the glenohumeral ligaments to anterior stability of the shoulder joint 显示文摘 | O' ConnellPW Nuber GW Mileski RA | 1990 | Am J Sports Med1990，18，6： | 1 |
| 13 | Localization of appendix with MDCT and influence of finding on choice of appendectomy incision显示文摘 | Oto A Emst RD MilesKi WJ | 2006 | AJR2006，187，4： | 1 |
| 14 | Inhibition of leukocytes-endothelial adherences following thermal injury显示文摘 | Mileski W Borgstrom D Lightfoot E | 1992 | J Surg Res1992，52，4： | 1 |
| 15 | Localization of appendix with MDCT and influence of findings on choice of appendectomy incision显示文摘 | Oto A Ernst RD Mileski WJ | 2006 | A JR2006，187，4： | 1 |
| 16 | Asian Options, the sum of lognormals and the reciprocal gammadistribution 显示文摘 | MILESKY M A POSNER E | 1998 | Journal of Financial and Quantitative analysis1998，33，3： | 1 |
| 17 | Sensitivity to endotoxin in rabbits is incresed after hemorrhagic shock显示文摘 | Mileski WJ Winn RK Harlan JM | 1992 | J Appl Phsiol1992，73，3： | 1 |
| 18 | Arthroscopic repair of medium to large full-thickness rotator cuff tears:outcome at 2- to 6-year follow-up显示文摘 | Murray TF Jr Lajtai G Mileski RM | 2002 | J Shoulder Elbow Surg2002，11，1： | 1 |
| 19 | Inhibition of leukocyte adherence and aggregation for treatment of severe cold injury in rabbits显示文摘 | Mileski W J Raymond J F Winn R K | 1993 | J Appl Physiol1993，74，3： | 1 |
| 20 | Inhibition of leukocyte adherence and aggregation for treatment of severe cold injury in rabbits显示文摘 | Mileski W J Raymond J F Winn R K | 1993 | Appl Physiol1993，74，3： | 1 |
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