Management and patient outcomes following admission with acute cholecystitis in Ireland: A national registry-based study.

Autor: O'Connell RM; Department of Hepatopancreaticobiliary Surgery, Mater Misericordiae University Hospital, Dublin, Ireland. Electronic address: robertmoconnell@rcsi.com., Hardy N; Department of Hepatopancreaticobiliary Surgery, Mater Misericordiae University Hospital, Dublin, Ireland., Ward L; Department of Hepatopancreaticobiliary Surgery, Mater Misericordiae University Hospital, Dublin, Ireland., Hand F; Department of Hepatopancreaticobiliary and Transplant Surgery, Saint Vincent's University Hospital, Dublin, Ireland., Maguire D; Department of Hepatopancreaticobiliary and Transplant Surgery, Saint Vincent's University Hospital, Dublin, Ireland., Stafford A; Department of Hepatopancreaticobiliary and Transplant Surgery, Saint Vincent's University Hospital, Dublin, Ireland., Gallagher TK; Department of Hepatopancreaticobiliary and Transplant Surgery, Saint Vincent's University Hospital, Dublin, Ireland., Hoti E; Department of Hepatopancreaticobiliary and Transplant Surgery, Saint Vincent's University Hospital, Dublin, Ireland., O'Sullivan AW; Department of Hepatopancreatobiliary Surgery, Mercy University Hospital, Cork, Ireland., Ó Súilleabháin CB; Department of Hepatopancreatobiliary Surgery, Mercy University Hospital, Cork, Ireland., Gall T; Department of Hepatopancreaticobiliary Surgery, Mater Misericordiae University Hospital, Dublin, Ireland., McEntee G; Department of Hepatopancreaticobiliary Surgery, Mater Misericordiae University Hospital, Dublin, Ireland., Conneely J; Department of Hepatopancreaticobiliary Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
Jazyk: angličtina
Zdroj: The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland [Surgeon] 2024 Dec; Vol. 22 (6), pp. 364-368. Date of Electronic Publication: 2024 Aug 14.
DOI: 10.1016/j.surge.2024.08.004
Abstrakt: Introduction: Acute cholecystitis is a common general surgical emergency, accounting for 3-10 % of all patients attending with acute abdominal pain. International guidelines suggest that emergency cholecystectomy is the treatment of choice for uncomplicated acute cholecystitis where feasible. There is a paucity of published data on the uptake of emergency cholecystectomy in Ireland.
Aim: The aim of this study was to evaluate the management of acute cholecystitis in Ireland and to establish the rate of emergency cholecystectomy performed.
Methods: All patients with acute cholecystitis presenting to public hospitals in Ireland between January 2017 and July 2023 were identified using the National Quality Assurance and Improvement System (NQAIS). Data were collected on patient demographics, co-morbidities, length of stay, operative intervention, endoscopic intervention, critical care admissions, in-patient mortality, and readmissions. Propensity score matched analysis and logistic regression were performed to account for selection bias in comparing patients managed with cholecystectomy and those managed conservatively.
Results: 20,886 admission episodes were identified involving 17,958 patients. 3585 (20 %) patients underwent emergency cholecystectomy in total. 3436 (96 %) of these were performed laparoscopically, with 140 (4 %) requiring conversion to an open procedure, and common bile duct injuries occurring in 4 (0.1 %) of patients. In comparison to patients treated conservatively, patients who underwent cholecystectomy were younger (median 50 v 60 years, p < 0.001) and more likely to be female (64 % v 55 % p < 0.001). Following propensity score matched analysis, those who had an emergency cholecystectomy had reduced length of stay (LOS) (median 5 days (IQR 3-8) v 6 days (interquartile range (IQR) 3-10), p < 0.001) and fewer readmissions to hospital (282 (8 %) v 492 (14 %), p < 0.001). On logistic regression, age >65 (OR 1.526), CCI >3 (OR 2.281) and non-operative management (OR 1.136) were significant risk factors for adverse outcome.
Conclusion: Uptake of emergency cholecystectomy in Ireland remains low, and is carried out on a younger, fitter cohort of patients. In those patients, however, it is associated with improved outcomes for cholecystitis compared to conservative management, including shorter LOS and reduced readmission rates for matched cohorts.
Competing Interests: Declaration of competing interest None to declare.
(Copyright © 2024 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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