慢性肾脏替代治疗急性胆囊炎患者的手术与非手术治疗。

IF 3.2 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepato‐Biliary‐Pancreatic Sciences Pub Date : 2025-03-25 DOI:10.1002/jhbp.12133

Dharmenaan Palamuthusingam, Carmel M Hawley, Elaine M Pascoe, David Wayne Johnson, Palvannan Sivalingam, Simon T Wood, Pranavan Palamuthusingam, Matthew D Jose, Magid Fahim

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引用次数: 0

摘要

背景：肾衰竭患者接受慢性肾脏替代治疗（KRT：透析或肾移植）有增加术后死亡率和发病率的风险。本研究评估急性胆囊炎慢性KRT患者行胆囊切除术与非手术治疗的结果。方法：这项两国人口队列研究使用澳大利亚和新西兰透析和移植登记处（ANZDATA）的关联数据和2000年至2015年的辖区医院入院数据集，评估了所有接受慢性KRT的事件和流行患者。初步诊断为急性胆囊炎的患者使用国际疾病分类（ICD）进行鉴定，并分为两组：接受胆囊切除术的患者和接受非手术治疗的患者。采用经合并症调整的Cox模型来确定胆囊切除术与30天和12个月死亡率的关系。结果：在接受慢性KRT治疗的46 779例患者中，有1520例患者最初以急性胆囊炎为急诊表现，其中87%接受了非手术治疗。两组之间30天死亡风险无差异（5.4%对5.1%,p = 0.83）。尽管包括复合心血管并发症（MI、CVA、心脏骤停：OR 2.08, 95% CI(1.13-3.81)）、ICU入院（OR 3.51, 95% CI(2.41-5.10)）和输血（OR 2.29, 95% CI(1.60-3.27)）在内的非致命性结局的发生率较高，但与非手术治疗相比，手术与12个月生存率的提高相关（HR 0.61, 95% CI(0.43-0.87)）。接受非手术治疗的患者30天再入院率更高（17.6比12.5%,p = 0.44）。结论：与非手术治疗相比，急性胆囊炎患者的12个月生存率更高，但早期发病率更高。

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Operative and nonoperative management of acute cholecystitis in patients on chronic kidney replacement therapy.

Background: Patients with kidney failure receiving chronic kidney replacement therapy (KRT: dialysis or kidney transplantation) have increased risks of postoperative mortality and morbidity. This study assesses the outcomes of acute cholecystitis in patients on chronic KRT who undergo cholecystectomy compared to nonoperative management.

Methods: This bi-national population cohort study evaluated all incident and prevalent patients receiving chronic KRT using linked data between Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and jurisdictional hospital admission datasets between 2000 and 2015. Patients with a primary diagnosis of acute cholecystitis were identified using the International Classification of Diseases (ICD) and were divided into two groups: patients who underwent cholecystectomy and those who received nonoperative management. Comorbidity-adjusted Cox models were used to determine the associations of cholecystectomy with 30-day and 12-month mortality.

Results: From the 46 779 patients on chronic KRT, there were 1520 patients with an initial emergency presentation of acute cholecystitis, of whom 87% received nonoperative management. Thirty-day mortality risk was no different between the two groups (5.4 vs. 5.1%, p = .83). Despite higher odds for nonfatal outcomes including composite cardiovascular complications (MI, CVA, cardiac arrest: OR 2.08, 95% CI (1.13-3.81)), ICU admission (OR 3.51, 95% CI (2.41-5.10)), and blood transfusions (OR 2.29, 95% CI (1.60-3.27)), surgery was associated with improved survival at 12 months compared with nonoperative management (HR 0.61, 95% CI (0.43-0.87)). Patients who received nonoperative management had a higher 30-day readmission rate (17.6 vs. 12.5%, p = .44).

Conclusions: In patients with acute cholecystitis, compared with nonoperative management, surgery was associated with better survival at 12 months but higher rates of early morbidity.

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来源期刊

Journal of Hepato‐Biliary‐Pancreatic Sciences GASTROENTEROLOGY & HEPATOLOGY-SURGERY

自引率

10.00%

发文量

178

审稿时长

6-12 weeks

期刊介绍： The Journal of Hepato-Biliary-Pancreatic Sciences (JHBPS) is the leading peer-reviewed journal in the field of hepato-biliary-pancreatic sciences. JHBPS publishes articles dealing with clinical research as well as translational research on all aspects of this field. Coverage includes Original Article, Review Article, Images of Interest, Rapid Communication and an announcement section. Letters to the Editor and comments on the journal’s policies or content are also included. JHBPS welcomes submissions from surgeons, physicians, endoscopists, radiologists, oncologists, and pathologists.