Percutaneous Cholecystostomy Tubes versus Medical Management for Acute Cholecystitis.

Autor:	Cook MD; College of Medicine, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA., Karim SA; Department of Health Administration, College of Health Professions, Virginia Commonwealth 6889University, Richmond, Virginia, USA., Jensen HK; Division of Trauma and Acute Care Surgery, Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA., Bennett JL; Division of Trauma and Acute Care Surgery, Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA., Burdine LJ; Division of Trauma and Acute Care Surgery, Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA., Bhavaraju A; Division of Trauma and Acute Care Surgery, Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA., Sexton KW; Division of Trauma and Acute Care Surgery, Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA.; Department of Biomedical Informatics, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA.; Department of Health Policy and Management, Fay W. Boozman College of Public Health, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA., Kalkwarf KJ; Division of Trauma and Acute Care Surgery, Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Jazyk:	angličtina
Zdroj:	The American surgeon [Am Surg] 2022 May; Vol. 88 (5), pp. 828-833. Date of Electronic Publication: 2021 Nov 08.
DOI:	10.1177/00031348211054567
Abstrakt:	Background: Cholecystitis is one of the most common infections treated surgically in the United States. Surgical risk is prohibitive in some patients, leading to alternative therapeutic strategies, including medical management (antibiotics) with or without percutaneous cholecystostomy tube (PCT) drainage. Materials and Methods: Using the Healthcare Cost and Utilization Project (HCUP) National Readmission Database (NRD), we performed a retrospective review to compare medically managed patients with or without PCT placement by evaluating 60-day readmissions rates, health care costs, and hospital length of stay (LOS). Both study groups were matched using the Elixhauser comorbidity index, age, and sex. Univariate and multivariate statistical analyses were performed using STATA. Results: 776,766 patients were included in the analysis. The population receiving PCT placement was on average 16 years older (69.9 vs 53.6 years; P < .01), less likely to be female (40.7% vs 59.3%; P < .01), and had almost twice as many comorbidities (3.36 vs 1.81; P < .01) compared to the population receiving medical management. After matching our data to account for these incongruities, PCT patients were still 10.4 times more likely to be readmitted, had a 11.6% increase in the cost of care, and a 37.6% increase in LOS compared to those managed medically. Discussion: Percutaneous cholecystostomy tube placement for cholecystitis is associated with a higher readmission rate, increased charges, and increased LOS compared to antibiotic therapy alone, even after correcting for age, sex, and comorbidities.
Databáze:	MEDLINE
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