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Li CL, Liu YK, Lan YY, Wang ZS. Association of education with cholelithiasis and mediating effects of cardiometabolic factors: A Mendelian randomization study. World J Clin Cases 2024; 12:4272-4288. [DOI: 10.12998/wjcc.v12.i20.4272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/10/2024] [Accepted: 06/03/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Education, cognition, and intelligence are associated with cholelithiasis occurrence, yet which one has a prominent effect on cholelithiasis and which cardiometabolic risk factors mediate the causal relationship remain unelucidated.
AIM To explore the causal associations between education, cognition, and intelligence and cholelithiasis, and the cardiometabolic risk factors that mediate the associations.
METHODS Applying genome-wide association study summary statistics of primarily European individuals, we utilized two-sample multivariable Mendelian randomization to estimate the independent effects of education, intelligence, and cognition on cholelithiasis and cholecystitis (FinnGen study, 37041 and 11632 patients, respectively; n = 486484 participants) and performed two-step Mendelian randomization to evaluate 21 potential mediators and their mediating effects on the relationships between each exposure and cholelithiasis.
RESULTS Inverse variance weighted Mendelian randomization results from the FinnGen consortium showed that genetically higher education, cognition, or intelligence were not independently associated with cholelithiasis and cholecystitis; when adjusted for cholelithiasis, higher education still presented an inverse effect on cholecystitis [odds ratio: 0.292 (95%CI: 0.171-0.501)], which could not be induced by cognition or intelligence. Five out of 21 cardiometabolic risk factors were perceived as mediators of the association between education and cholelithiasis, including body mass index (20.84%), body fat percentage (40.3%), waist circumference (44.4%), waist-to-hip ratio (32.9%), and time spent watching television (41.6%), while time spent watching television was also a mediator from cognition (20.4%) and intelligence to cholelithiasis (28.4%). All results were robust to sensitivity analyses.
CONCLUSION Education, cognition, and intelligence all play crucial roles in the development of cholelithiasis, and several cardiometabolic mediators have been identified for prevention of cholelithiasis due to defects in each exposure.
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Affiliation(s)
- Chang-Lei Li
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Yu-Kun Liu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Ying-Ying Lan
- Department of Oncology Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266002, Shandong Province, China
| | - Zu-Sen Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
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2
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Srikumar G, McGuinness MJ, Kau N, Wells C, Harmston C. Cost analysis of index versus delayed cholecystectomy for acute cholecystitis in a New Zealand Provincial Centre. ANZ J Surg 2022; 92:1675-1680. [PMID: 35666130 DOI: 10.1111/ans.17829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Evidence suggests index cholecystectomy (IC) in patients with acute cholecystitis is safe, has decreased hospital stay and is cheaper than delayed cholecystectomy (DC). Costs of cholecystectomy have not previously been investigated in New Zealand. The aim of this study was to compare cost of IC with DC for patients with acute cholecystitis. METHODS A retrospective analysis of adults admitted to Northland hospitals with acute cholecystitis between 1 January 2015 and 31 December 2019 who underwent subsequent cholecystectomy, was performed. Actual patient-level costs were utilized for cost comparison between IC and DC. Factors associated with increased costs were assessed using multivariate analysis. RESULTS Two hundred and eleven patients were included in the study; 72 (34%) underwent IC and 139 (65%) DC. There was no significant difference in total cost for IC ($12 767) versus DC ($12 029) (p = 0.192); this persisted on multivariate analysis. Patients having IC had more severe cholecystitis, and 90-day representation rate following DC was 35%. Costs were increased by severity of cholecystitis, age, American Society of Anesthesiology score (ASA) and travel distance. CONCLUSION This study showed there is no significant difference in cost between IC and DC for patients with acute cholecystitis in Northland, New Zealand. Severity, increasing age, ASA and travel distance were drivers of costs. To recognize the cost benefits of IC, it is likely that increased rates of IC are needed.
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Affiliation(s)
- Gajan Srikumar
- Department of General Surgery, Whangarei Hospital, Northland District Health Board, Whangarei, New Zealand
| | - Matthew James McGuinness
- Department of General Surgery, Whangarei Hospital, Northland District Health Board, Whangarei, New Zealand.,Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Niki Kau
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Cameron Wells
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Christopher Harmston
- Department of General Surgery, Whangarei Hospital, Northland District Health Board, Whangarei, New Zealand.,Department of Surgery, The University of Auckland, Auckland, New Zealand
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3
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Biffl WL, Lu N, Schultz PR, Wang J, Castelo MR, Schaffer KB. Improving length of stay on a trauma service. Trauma Surg Acute Care Open 2021; 6:e000744. [PMID: 34527812 PMCID: PMC8395366 DOI: 10.1136/tsaco-2021-000744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/02/2021] [Indexed: 11/04/2022] Open
Abstract
Background Reducing length of stay (LOS) is a major healthcare initiative. While LOS is closely linked to the diagnosis and procedure in elective surgery, many additional factors influence LOS on a trauma service. We hypothesized that more standardized patient management would lead to decreased LOS. Methods Retrospective analysis of Trauma Registry data compared LOS before (PRE) and after (POST) implementation of standardized processes on a trauma service. Patients were subdivided by age (over and under 65 years). Data were compared using unpaired t-test, χ2 test and analysis of variance tests, where appropriate. Results 1613 PRE and 1590 POST patients were compared. Although age and Injury Severity Score were similar, median LOS decreased by 1 day for the group overall (p<0.0001), and for subgroups over and under the age of 65 years (p<0.0001). Older patients were discharged home 13% more often in POST, compared with 4% more for younger patients. Conclusions Improved standardization of processes on a trauma service reduced LOS in patients of all ages. A prospective study may identify specific factors associated with prolonged LOS, to allow further improvement. Level of evidence III. Study type Therapeutic/Care management.
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Affiliation(s)
- Walter L Biffl
- Trauma, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
| | - Ning Lu
- Trauma, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
| | - Peter R Schultz
- Trauma, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
| | - Jiayan Wang
- Trauma, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
| | - Matthew R Castelo
- Trauma, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
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4
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Patients with acute cholecystitis should be admitted to a surgical service. J Trauma Acute Care Surg 2020; 87:870-875. [PMID: 31233439 DOI: 10.1097/ta.0000000000002415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In bowel obstruction and biliary pancreatitis, patients receive more expedient surgical care when admitted to surgical compared with medical services. This has not been studied in acute cholecystitis. METHODS Retrospective analysis of clinical and cost data from July 2013 to September 2015 for patients with cholecystitis who underwent laparoscopic cholecystectomy in a tertiary care inpatient hospital. One hundred ninety lower-risk (Charlson-Deyo) patients were included. We assessed admitting service, length of stay (LOS), time from admission to surgery, time from surgery to discharge, number of imaging studies, and total cost. RESULTS Patients admitted to surgical (n = 106) versus medical (n = 84) service had shorter mean LOS (1.4 days vs. 2.6 days), shorter time from admission to surgery (0.4 days vs. 0.8 days), and shorter time from surgery to discharge (0.8 days vs. 1.1 days). Surgical service patients had fewer CT (38% vs. 56%) and magnetic resonance imaging (MRI) (5% vs. 16%) studies. Cholangiography (30% vs. 25%) and endoscopic retrograde cholangiopancreatography (ERCP) (3 vs. 8%) rates were similar. Surgical service patients had 39% lower median total costs (US $7787 vs. US $12572). CONCLUSION Nonsurgical admissions of patients with cholecystitis are common, even among lower-risk patients. Routine admission to the surgical service should decrease LOS, resource utilization and costs. LEVEL OF EVIDENCE Therapeutic/care management, level IV.
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5
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The heavy price of conversion from laparoscopic to open procedures for emergent cholecystectomies. Am J Surg 2019; 217:732-738. [DOI: 10.1016/j.amjsurg.2018.12.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/16/2018] [Accepted: 12/18/2018] [Indexed: 01/06/2023]
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6
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Bernard ET, Davenport DL, Collins CM, Benton BA, Bernard AC. Time is money: quantifying savings in outpatient appendectomy. Trauma Surg Acute Care Open 2018; 3:e000222. [PMID: 30687784 PMCID: PMC6326335 DOI: 10.1136/tsaco-2018-000222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/30/2018] [Accepted: 12/05/2018] [Indexed: 11/20/2022] Open
Abstract
Background Laparoscopic appendectomy can be performed on a fast-track, short-stay, or outpatient basis with high success rates, low morbidity, low readmission rates, and shorter length of hospital stay. Cost savings from outpatient appendectomy have not been well described. We hypothesize that outpatient laparoscopic appendectomy is associated with cost savings. Methods We performed an original retrospective cohort analysis of patients undergoing laparoscopic appendectomy between June 2013 and April 2017 at our academic medical center before and after implementation of an outpatient protocol which began on January 1, 2016. We assessed appendicitis grade, length of stay (LOS), cost, net revenue, and profit margin. Results After protocol implementation, the percentage of patients discharged from the the postanesthesia care unit (PACU) increased from 3.7% to 29.7% (χ2 p<0.001). The proportion of inpatient admissions and admissions to observation decreased by 5.7% and 20.3%, respectively. On average, PACU-to-home patients had a total hospital cost of $4734 compared with $5781 in patients admitted to observation, for an estimated savings of $1047 per patient (p<0.001). Comparing the time periods, the mean LOS decreased for all groups (p<0.001). Appendicitis grade was higher in those who required inpatient admission, but could not distinguish which patients required an observation bed. Discussion Outpatient appendectomy saves approximately $1000 per patient. Adoption of an outpatient appendectomy pathway is likely to be gradual, but will result in incremental improvement in resource utilization immediately. Grade does not predict which patients should be observed. Considering established safety, our data support widespread implementation of this protocol. Level of evidence III.
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Affiliation(s)
- Elise Taylor Bernard
- Department of Surgery, Acute Care Surgery, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Daniel L Davenport
- Department of Surgery, Acute Care Surgery, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Courtney M Collins
- Department of Surgery, Acute Care Surgery, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Bethany A Benton
- Department of Surgery, Acute Care Surgery, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Andrew C Bernard
- Department of Surgery, Acute Care Surgery, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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7
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Murray AC, Markar S, Mackenzie H, Baser O, Wiggins T, Askari A, Hanna G, Faiz O, Mayer E, Bicknell C, Darzi A, Kiran RP. An observational study of the timing of surgery, use of laparoscopy and outcomes for acute cholecystitis in the USA and UK. Surg Endosc 2018; 32:3055-3063. [PMID: 29313126 DOI: 10.1007/s00464-017-6016-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 12/19/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Evidence supports early laparoscopic cholecystectomy for acute cholecystitis. Differences in treatment patterns between the USA and UK, associated outcomes and resource utilization are not well understood. METHODS In this retrospective, observational study using national administrative data, emergency patients admitted with acute cholecystitis were identified in England (Hospital Episode Statistics 1998-2012) and USA (National Inpatient Sample 1998-2011). Proportions of patients who underwent emergency cholecystectomy, utilization of laparoscopy and associated outcomes including length of stay (LOS) and complications were compared. The effect of delayed treatment on subsequent readmissions was evaluated for England. RESULTS Patients with a diagnosis of acute cholecystitis totaled 1,191,331 in the USA vs. 288 907 in England. Emergency cholecystectomy was performed in 628,395 (52.7% USA) and 45,299 (15.7% England) over the time period. Laparoscopy was more common in the USA (82.8 vs. 37.9%; p < 0.001). Pre-treatment (1 vs. 2 days; p < 0.001) and total ( 4 vs. 7 days; p < 0.001) LOS was lower in the USA. Overall incidence of bile duct injury was higher in England than the USA (0.83 vs. 0.43%; p < 0.001), but was no different following laparoscopic surgery (0.1%). In England, 40.5% of patients without an immediate cholecystectomy were subsequently readmitted with cholecystitis. An additional 14.5% were admitted for other biliary complications, amounting to 2.7 readmissions per patient in the year following primary admission. CONCLUSION This study highlights management practices for acute cholecystitis in the USA and England. Despite best evidence, index admission laparoscopic cholecystectomy is performed less in England, which significantly impacts subsequent healthcare utilization.
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Affiliation(s)
- A C Murray
- Division of Colorectal Surgery, New York Presbyterian Hospital/Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor: 8, New York, NY, 10032, USA.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - S Markar
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - H Mackenzie
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - O Baser
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - T Wiggins
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Askari
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - G Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - O Faiz
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - E Mayer
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - C Bicknell
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - R P Kiran
- Division of Colorectal Surgery, New York Presbyterian Hospital/Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor: 8, New York, NY, 10032, USA. .,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA.
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8
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Rojas-García A, Turner S, Pizzo E, Hudson E, Thomas J, Raine R. Impact and experiences of delayed discharge: A mixed-studies systematic review. Health Expect 2017; 21:41-56. [PMID: 28898930 PMCID: PMC5750749 DOI: 10.1111/hex.12619] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 11/27/2022] Open
Abstract
Background The impact of delayed discharge on patients, health‐care staff and hospital costs has been incompletely characterized. Aim To systematically review experiences of delay from the perspectives of patients, health professionals and hospitals, and its impact on patients’ outcomes and costs. Methods Four of the main biomedical databases were searched for the period 2000‐2016 (February). Quantitative, qualitative and health economic studies conducted in OECD countries were included. Results Thirty‐seven papers reporting data on 35 studies were identified: 10 quantitative, 8 qualitative and 19 exploring costs. Seven of ten quantitative studies were at moderate/low methodological quality; 6 qualitative studies were deemed reliable; and the 19 studies on costs were of moderate quality. Delayed discharge was associated with mortality, infections, depression, reductions in patients’ mobility and their daily activities. The qualitative studies highlighted the pressure to reduce discharge delays on staff stress and interprofessional relationships, with implications for patient care and well‐being. Extra bed‐days could account for up to 30.7% of total costs and cause cancellations of elective operations, treatment delay and repercussions for subsequent services, especially for elderly patients. Conclusions The poor quality of the majority of the research means that implications for practice should be cautiously made. However, the results suggest that the adverse effects of delayed discharge are both direct (through increased opportunities for patients to acquire avoidable ill health) and indirect, secondary to the pressures placed on staff. These findings provide impetus to take a more holistic perspective to addressing delayed discharge.
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Affiliation(s)
- Antonio Rojas-García
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, UK
| | - Simon Turner
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, UK
| | - Elena Pizzo
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, UK
| | - Emma Hudson
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, UK
| | - James Thomas
- Institute of Education EPPI-Centre, University College London, London, UK
| | - Rosalind Raine
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, UK
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9
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Bhandari M, Wilson C, Rifkind K, DiMaggio C, Ayoung-Chee P. Prolonged length of stay in delayed cholecystectomy is not due to intraoperative or postoperative contributors. J Surg Res 2017; 219:253-258. [PMID: 29078891 DOI: 10.1016/j.jss.2017.05.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 04/20/2017] [Accepted: 05/25/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Previous studies have reported that same-day laparoscopic cholecystectomy for acute cholecystitis is superior to delayed elective cholecystectomy. Although this practice is ideal, it requires significant hospital resources, particularly for an underprivileged inner-city population at a large, municipal hospital. We sought to evaluate the implementation of same-day laparoscopic cholecystectomy in a large, municipal hospital and assess the possible benefits of decreasing preoperative length of stay (LOS), particularly its effect on operative time and length of stay in patients with acute cholecystitis. MATERIALS AND METHODS This was a retrospective chart review of patients treated for symptomatic gallstone disease between September 2012 and November 2013. Medical records were reviewed, and relevant data points were collected. Univariate and multivariate regressions were performed to assess the correlation between time to operation (<36 h [no delay] or >36 h [delay]) and the main outcomes (operative time and total length of stay). Inclusion criteria were patients age ≥18 y who underwent same-admission cholecystectomy and had a diagnosis of cholecystitis on pathology. Eighty-eight patients met all inclusion criteria. RESULTS The mean (standard deviation) preoperative LOS was 76.2 (±48.6) h, the mean operative time was 2.3 (±1.1) h, and the mean postoperative LOS was 60.3 (±60.1) h. The average total LOS was 136 (±79.8) h. Operative times and postoperative LOS were similar for patients in the delay and no delay groups. Patients with >36 h wait before surgery had a total length of stay twice as long as patients with <36 h wait (152 versus 83.3 h; P = 0.0005). These findings remained significant when adjusted for age, sex, radiologic findings, number of preoperative tests, and pathology. CONCLUSIONS Increased preoperative LOS is not associated with a significant increase in operative time. However, it was associated with significantly increased length of stay. Further analysis is needed to explore the potential cost savings of decreasing preoperative LOS.
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Affiliation(s)
- Misha Bhandari
- Department of Surgery, New York University School of Medicine, New York, New York; New York Presbyterian, The University Hospital of Columbia and Cornell, Department of Emergency Medicine, New York, New York
| | - Chad Wilson
- Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Kenneth Rifkind
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Charles DiMaggio
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Patricia Ayoung-Chee
- Department of Surgery, New York University School of Medicine, New York, New York.
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10
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Macedo FIB, Eid JJ, Mittal VK, Flynn J, Jacobs MJ, Pearlman R. Impact of medical or surgical admission on outcomes of patients with acute cholecystitis. HPB (Oxford) 2017; 19:99-103. [PMID: 27993464 DOI: 10.1016/j.hpb.2016.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 11/03/2016] [Accepted: 11/22/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although acute cholecystitis (AC) is a surgical disease, patients with the condition may be admitted to medical-related services (MS). This may lead to delayed cholecystectomy thereby affecting outcomes and quality of care. METHODS Between July 2010 and March 2013, 329 patients under 70 years old presented to a community-based tertiary care hospital with AC and underwent same admission cholecystectomy. Outcomes were compared between patients admitted to MS and surgical services (SS). RESULTS Two hundred fifteen patients (65.3%) were admitted to a MS. Patients under the MS had longer LOS (3.0 days vs. 2.0 days, p < 0.001), waiting time to surgical consultation (7.3 h vs. 5.0 h, p < 0.001) and to cholecystectomy (1.0, 0-2 days vs. 1.0, 0-1 day, p < 0.001), and increased hospital costs ($3685 vs. $4,688, p < 0.001) compared to the SS. Readmission and mortality rates were not significantly different between groups. CONCLUSION Patients under 70 years old with AC undergoing cholecystectomy admitted to MS had increased LOS, delay to the operation, and hospital costs compared to those admitted to a SS. Admission of patients with AC to a SS needs to be emphasized to reduce costs and improve quality of care.
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Affiliation(s)
- Francisco Igor B Macedo
- Department of Surgery, Providence Hospital and Medical Centers, Michigan State University College of Human Medicine, Southfield, MI, USA.
| | - Joseph J Eid
- Department of Surgery, Providence Hospital and Medical Centers, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Vijay K Mittal
- Department of Surgery, Providence Hospital and Medical Centers, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Jeffrey Flynn
- Division of Biostatistics, Department of Graduate Medical Education, Providence Hospital and Medical Centers, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Michael J Jacobs
- Department of Surgery, Providence Hospital and Medical Centers, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Ralph Pearlman
- Department of Surgery, Providence Hospital and Medical Centers, Michigan State University College of Human Medicine, Southfield, MI, USA
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11
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Timing of cholecystectomy following endoscopic sphincterotomy: a population-based study. Surg Endosc 2016; 31:2977-2985. [DOI: 10.1007/s00464-016-5316-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 10/25/2016] [Indexed: 12/20/2022]
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12
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Mitchell M. Day surgery nurses' selection of patient preoperative information. J Clin Nurs 2016; 26:225-237. [DOI: 10.1111/jocn.13375] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Mark Mitchell
- School of Nursing, Midwifery, Social Work & Social Sciences; University of Salford; Salford Greater Manchester UK
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13
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Portincasa P, Di Ciaula A, de Bari O, Garruti G, Palmieri VO, Wang DQH. Management of gallstones and its related complications. Expert Rev Gastroenterol Hepatol 2016; 10:93-112. [PMID: 26560258 DOI: 10.1586/17474124.2016.1109445] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The majority of gallstone patients remain asymptomatic; however, interest toward the gallstone disease is continuing because of the high worldwide prevalence and management costs and the development of gallstone symptoms and complications. For cholesterol gallstone disease, moreover, a strong link exists between this disease and highly prevalent metabolic disorders such as obesity, dyslipidemia, type 2 diabetes, hyperinsulinemia, hypertriglyceridemia and the metabolic syndrome. Information on the natural history as well as the diagnostic, surgical (mainly laparoscopic cholecystectomy) and medical tools available to facilitate adequate management of cholelithiasis and its complications are, therefore, crucial to prevent the negative outcomes of gallstone disease. Moreover, some risk factors for gallstone disease are modifiable and some preventive strategies have become necessary to reduce the onset and the severity of complications.
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Affiliation(s)
- P Portincasa
- a Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri" , University of Bari Medical School , Bari , Italy
| | - A Di Ciaula
- b Division of Internal Medicine , Hospital of Bisceglie , Bisceglie , Italy
| | - O de Bari
- a Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri" , University of Bari Medical School , Bari , Italy
- d Department of Internal Medicine, Division of Gastroenterology and Hepatology , Saint Louis University School of Medicine , St. Louis , MO , USA
| | - G Garruti
- c Department of Emergency and Organ Transplants, Section of Endocrinology, Andrology and Metabolic Diseases , University of Bari Medical School , Bari , Italy
| | - V O Palmieri
- a Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri" , University of Bari Medical School , Bari , Italy
| | - D Q-H Wang
- d Department of Internal Medicine, Division of Gastroenterology and Hepatology , Saint Louis University School of Medicine , St. Louis , MO , USA
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