胆结石性胰腺炎术中胆道造影后使用率和再入院率的全国趋势

IF 1.4 Q3 SURGERY
Ayesha P. Ng , Troy N. Coaston , Konmal Ali , Christian de Virgilio , Peyman Benharash
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引用次数: 0

摘要

在没有胆管炎的情况下,术中胆管造影(IOC)在轻度胆源性胰腺炎(GSP)中排除结石残留的作用仍然存在争议。使用一个具有全国代表性的数据库,我们检查了IOC的当代使用情况和指数结果以及胆囊切除术后GSP的再入院情况。方法选取2017-2021年全国再入院数据库中所有因轻度GSP接受非选择性胆囊切除术的成年人。根据IOC的使用对患者进行分层。使用多变量回归和Royston-Parmar分析来评估IOC使用与感兴趣的结果的关联。结果152,687例患者中,24.7%接受了IOC。在研究期间,IOC的利用率从26.5%显著下降到20.7% (p <;0.001)。与没有IOC的患者相比,IOC患者年龄较大,更常在大容量的私立医院接受治疗。经过风险调整后,主要不良事件(包括死亡率、并发症和胆管损伤修复)的发生率在队列之间具有可比性。此外,住院时间和住院费用在有和没有IOC的患者之间具有可比性。值得注意的是,IOC与复发性胰腺炎或结石潴留的90天再入院率降低20%显著相关(AOR 0.80 [95% CI 0.74-0.86])。结论sioc与GSP胆囊切除术后再入院率显著降低和资源利用率相当相关。尽管其使用率下降,但IOC可能是一种具有成本效益的策略,有助于降低轻度GSP患者复发性胆道疾病的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
National trends in utilization and readmission following intraoperative cholangiography in gallstone pancreatitis

Background

In the absence of cholangitis, the role of intraoperative cholangiography (IOC) to exclude retained stones in mild gallstone pancreatitis (GSP) remains controversial. Using a nationally representative database, we examined the contemporary utilization of IOC and index outcomes and readmission following cholecystectomy for GSP.

Methods

All adults undergoing nonelective cholecystectomy for mild GSP in the 2017–2021 Nationwide Readmissions Database were identified. Patients were stratified based on the use of IOC. Multivariable regressions and Royston-Parmar analysis were used to evaluate the association of IOC use with outcomes of interest.

Results

Of 152,687 patients, 24.7 % underwent IOC. Utilization of IOC significantly decreased from 26.5 % to 20.7 % over the study period (p < 0.001). Compared to patients without IOC, IOC patients were older and more commonly treated at high-volume, private hospitals. Following risk adjustment, the odds of major adverse events, including mortality, complications, and bile duct injury repair were comparable between cohorts. Furthermore, length of stay and hospitalization costs were comparable between patients with and without IOC. Notably, IOC was significantly associated with 20 % decreased odds of 90-day readmission for recurrent pancreatitis or retained stone, which persisted over time (AOR 0.80 [95 % CI 0.74–0.86]).

Conclusions

IOC was associated with significantly reduced readmission and comparable resource use following cholecystectomy for GSP. Despite its decreasing utilization, IOC may be a cost-effective strategy to help reduce risk for recurrent biliary disease among patients with mild GSP.
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CiteScore
1.30
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