کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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6253917 | 1612527 | 2014 | 5 صفحه PDF | دانلود رایگان |

BackgroundAcute acalculous cholecystitis is often managed with cholecystectomy or cholecystostomy, but data guiding surgical practice are lacking.Materials and methodsLongitudinal analysis of the California Office of Statewide Health Planning and Development Patient Discharge Data was performed from 1995-2009. Patients with acute acalculous cholecystitis were identified by International Classification of Diseases 9 code. Cox proportional hazard analysis found predictors of time to death, adjusting for patient demographics, sepsis, shock, frailty, Charlson comorbidity index, length of stay, insurance status, teaching hospital status, and year.ResultsOf 43,341 patients, 63.5% received a cholecystectomy, 2.8% received a cholecystostomy, and 1.2% received both. Overall, 30.4% of patients died, with higher mortality among patients with cholecystostomy (61.7%) or no procedure (42.0%) than cholecystectomy (23.0%). In patients with severe sepsis and shock, there was no difference in survival of patients with cholecystostomy versus no intervention (hazard ratio [HR] 1.13, PÂ =Â 0.256), although patients with cholecystectomy (with or without prior cholecystostomy) had improved survival (HR 0.29, PÂ <Â 0.001; HR 0.56, PÂ <Â 0.001). Results were similar among patients on the ventilator >96Â h.ConclusionsAlthough cholecystostomy offered no survival benefit for patients with severe sepsis and shock, cholecystectomy offered improved survival compared with patients without surgical management. Cholecystostomy may not benefit the sickest patients in whom cholecystectomy may never be considered.
Journal: Journal of Surgical Research - Volume 190, Issue 2, August 2014, Pages 517-521