与非肝胆管外科医生相比，肝胆管外科医生进行急诊指数入院腹腔镜胆囊切除术的结果更好吗？使用1:1倾向评分匹配的10年审计。

IF 3.6 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hepatobiliary & Pancreatic Diseases International Pub Date : 2024-12-01 DOI:10.1016/j.hbpd.2023.08.002

Kai Siang Chan , Samantha Baey , Vishal G Shelat , Sameer P Junnarkar

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引用次数: 0

摘要

背景：急诊入院胆囊切除术（EIC）在大多数情况下被推荐用于急性胆囊炎。普通外科医生在处理“困难”的胆囊切除术方面的经验较少。本研究旨在比较肝胆胰（HPB）与非HPB外科医生的EIC结果。方法：对2011年12月至2022年3月期间接受EIC治疗的患者进行10年回顾性审计。既往行开放胆囊切除术、既往胆囊炎、既往内镜逆行胆管造影或胆囊造瘘的患者被排除在外。采用1:1倾向评分匹配（PSM）来调整混杂变量（如年龄≥75岁、腹部手术史、存在致密粘连）。结果：未匹配队列中有1409例患者（HPB 684例，非HPB 725例）。男性占52.3%，平均年龄59.2±14.9岁。472例（33.5%）EIC患者就诊后≥72小时，40.1%患者有致密粘连。任意发病率、开腹转换、胆囊次全切除术和胆管损伤的发生率分别为12.4%、5.0%、14.6%和0.1%。EIC术后30天内死亡1例。PSM患者1166例（每组583例）。HPB术者EIC手术时间较短（115.5 min vs 133.4 min, P < 0.001）。平均住院时间具有可比性。HPB外科手术的EIC与较低的开腹转换(比值比（OR) = 0.24, 95%可信区间（CI）： 0.12-0.49, P < 0.001）、较低的底先胆囊切除术（OR = 0.58, 95% CI: 0.35-0.95, P = 0.032）、较高的次全胆囊切除术（OR = 4.19, 95% CI: 2.24-7.84, P < 0.001）独立相关。两组之间的任何发病率、胆管损伤和死亡率均具有可比性。结论：由HPB外科医生进行EIC手术与更短的手术时间和更低的开放转换风险相关。然而，胆囊次全切除术的发生率较高。

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Are outcomes for emergency index-admission laparoscopic cholecystectomy performed by hepatopancreatobiliary surgeons better compared to non-hepatopancreatobiliary surgeons? A 10-year audit using 1:1 propensity score matching

Background

Emergency index-admission cholecystectomy (EIC) is recommended for acute cholecystitis in most cases. General surgeons have less exposure in managing “difficult” cholecystectomies. This study aimed to compare the outcomes of EIC between hepatopancreatobiliary (HPB) versus non-HPB surgeons.

Methods

This is a 10-year retrospective audit on patients who underwent EIC from December 2011 to March 2022. Patients who underwent open cholecystectomy, had previous cholecystitis, previous endoscopic retrograde cholangiopancreatography or cholecystostomy were excluded. A 1:1 propensity score matching (PSM) was performed to adjust for confounding variables (e.g. age ≥ 75 years, history of abdominal surgery, presence of dense adhesions).

Results

There were 1409 patients (684 HPB cases, 725 non-HPB cases) in the unmatched cohort. Majority (52.3%) of them were males with a mean age of 59.2 ± 14.9 years. Among 472 (33.5%) patients with EIC performed ≥ 72 hours after presentation, 40.1% had dense adhesion. The incidence of any morbidity, open conversion, subtotal cholecystectomy and bile duct injury were 12.4%, 5.0%, 14.6% and 0.1%, respectively. There was one mortality within 30 days from EIC. PSM resulted in 1166 patients (583 per group). Operative time was shorter when EIC was performed by HPB surgeons (115.5 vs. 133.4 min, P < 0.001). The mean length of hospital stay was comparable. EIC performed by HPB surgeons was independently associated with lower open conversion [odds ratio (OR) = 0.24, 95% confidence interval (CI): 0.12–0.49, P < 0.001], lower fundus-first cholecystectomy (OR = 0.58, 95% CI: 0.35–0.95, P = 0.032), but higher subtotal cholecystectomy (OR = 4.19, 95% CI: 2.24–7.84, P < 0.001). Any morbidity, bile duct injury and mortality were comparable between the two groups.

Conclusions

EIC performed by HPB surgeons were associated with shorter operative time and reduced risk of open conversion. However, the incidence of subtotal cholecystectomy was higher.

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来源期刊

Hepatobiliary & Pancreatic Diseases International 医学-胃肠肝病学

CiteScore

5.40

自引率

6.10%

发文量

152

审稿时长

3.0 months

期刊介绍： Hepatobiliary & Pancreatic Diseases International (HBPD INT) (ISSN 1499-3872 / CN 33-1391/R) a bimonthly journal published by First Affiliated Hospital, Zhejiang University School of Medicine, China. It publishes peer-reviewed original papers, reviews and editorials concerned with clinical practice and research in the fields of hepatobiliary and pancreatic diseases. Papers cover the medical, surgical, radiological, pathological, biochemical, physiological and historical aspects of the subject areas under the headings Liver, Biliary, Pancreas, Transplantation, Research, Special Reports, Editorials, Review Articles, Brief Communications, Clinical Summary, Clinical Images and Case Reports. It also deals with the basic sciences and experimental work. The journal is abstracted and indexed in SCI-E, IM/MEDLINE, EMBASE/EM, CA, Scopus, ScienceDirect, etc.