Digestive surgery · 2014
Early versus delayed surgery for acute cholecystitis as an applied treatment strategy when assessed in a population-based cohort.
Сравнительное исследованиеОценочное исследованиеСтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Pieniowski Emil, Popowicz Agnieszka, Lundell Lars, Gerber Peter, Gustafsson Ulf, Sinabulya Helen, Sjödahl Krister, Tsekrekos Andrianos, Sandblom Gabriel
Аннотация
BACKGROUND: The aims of this study were to describe the surgical management of acute cholecystitis (AC) in a well-defined population-based patient cohort, in particular adherence to and outcome of the early open/laparoscopic cholecystectomy (EC/ELC) strategy.
METHODS: The medical records of all patients residing in Stockholm County who were treated for AC during 2003 and 2008 were reviewed according to a standardized protocol.
RESULTS: In 2003, 799 patients were admitted 850 times for AC, and the respective figures for 2008 were 833 and 919. The number of patients who underwent EC/ELC increased from 42.9% in 2003 to 47.4% in 2008. In multivariate regression analysis adjusting for age, gender, severity of cholecystitis, maximal CRP and maximal WBC, EC/ELC was associated with shorter operation time but higher perioperative blood loss when compared to delayed open/laparoscopic cholecystectomy (DC/DLC). The odds ratio for completing the procedure laparoscopically was significantly higher in DC/DLC when adjusting for the same covariates. There were no significant differences in peri- or postoperative complications between the groups.
CONCLUSION: Strategies should be implemented in order to secure a more evidence-based approach to the surgical treatment of AC.
METHODS: The medical records of all patients residing in Stockholm County who were treated for AC during 2003 and 2008 were reviewed according to a standardized protocol.
RESULTS: In 2003, 799 patients were admitted 850 times for AC, and the respective figures for 2008 were 833 and 919. The number of patients who underwent EC/ELC increased from 42.9% in 2003 to 47.4% in 2008. In multivariate regression analysis adjusting for age, gender, severity of cholecystitis, maximal CRP and maximal WBC, EC/ELC was associated with shorter operation time but higher perioperative blood loss when compared to delayed open/laparoscopic cholecystectomy (DC/DLC). The odds ratio for completing the procedure laparoscopically was significantly higher in DC/DLC when adjusting for the same covariates. There were no significant differences in peri- or postoperative complications between the groups.
CONCLUSION: Strategies should be implemented in order to secure a more evidence-based approach to the surgical treatment of AC.
Предметные рубрики MeSH
AdultAgedAnalysis of VarianceCholecystectomyCholecystectomy, LaparoscopicCholecystitis, AcuteCohort StudiesFemaleFollow-Up StudiesHumansLaparotomyLength of StayMaleMiddle AgedObserver VariationOperative TimePain MeasurementPostoperative PainPostoperative ComplicationsReproducibility of ResultsRisk AssessmentSeverity of Illness IndexSwedenTime-to-TreatmentTreatment Outcome