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Lee SY, Jang SI, Cho JH, Do MY, Lee SY, Choi A, Lee HS, Yang J, Lee DK. Gallstone Dissolution Effects of Combination Therapy with n-3 Polyunsaturated Fatty Acids and Ursodeoxycholic Acid: A Randomized, Prospective, Preliminary Clinical Trial. Gut Liver 2024; 18:1069-1079. [PMID: 38712398 PMCID: PMC11565012 DOI: 10.5009/gnl230494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 05/08/2024] Open
Abstract
Background/Aims : Ursodeoxycholic acid (UDCA) is the only well-established and widely used agent for dissolving gallstones. Epidemiological and animal studies have suggested potential therapeutic benefits of n-3 polyunsaturated fatty acids (PUFA) for dissolving cholesterol gallstones. We evaluated whether adding PUFA to UDCA improves gallstone dissolution in patients with cholesterol gallstones. Methods : This randomized, prospective, preliminary clinical trial compared the efficacy and safety of UDCA plus PUFA combination therapy (combination group) with those of UDCA monotherapy (monotherapy group). The inclusion criteria were a gallstone diameter ≤15 mm on ultrasonography, radiolucent stones on plain X-ray, and no to mild symptoms. Gallstone dissolution rates, response rates, and adverse events were evaluated. Results : Of the 59 screened patients, 45 patients completed treatment (24 and 21 in the monotherapy and combination groups, respectively). The gallstone dissolution rate tended to be higher in the combination group than in the monotherapy group (45.7% vs 9.9%, p=0.070). The radiological response rate was also significantly higher in the combination group (90.5% vs 41.7%, p=0.007). In both groups, dissolution and response rates were higher in patients with gallbladder sludge than in those with distinct stones. Four adverse events (two in each group) were observed, none of which were study drug-related or led to drug discontinuation. The incidence of these adverse events was similar in both groups (combination vs monotherapy: 9.5% vs 8.3%, p=0.890). Conclusions : UDCA plus PUFA therapy dissolves cholesterol gallstones more effectively than UDCA monotherapy, without significant complications. Further prospective, large-scale studies of this combination therapy are warranted.
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Affiliation(s)
- See Young Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Ill Jang
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hee Cho
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Young Do
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Su Yeon Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Arong Choi
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Juyeon Yang
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Lee MH, Jang Y, Kang E, Kim YC, Min S, Lee SH, Cho IR, Paik WH, Lee H. Silent gallbladder stone in kidney transplantation recipients: should it be treated? A retrospective cohort study. Int J Surg 2024; 110:3571-3579. [PMID: 38573083 PMCID: PMC11175749 DOI: 10.1097/js9.0000000000001394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/11/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Treatment and follow-up strategies for silent gallbladder stones in patients before kidney transplantation (KT) remain unknown. Therefore, the authors aimed to elucidate the role of pre-KT cholecystectomy in preventing biliary and surgical complications. MATERIALS AND METHODS This study retrospectively analyzed 2295 KT recipients and 3443 patients waiting for KT at a single tertiary center from January 2005 to July 2022. The primary outcomes were the incidences of biliary and postcholecystectomy complications in KT recipients. Firth's logistic regression model was used to assess the risk factors for biliary complications. RESULTS Overall, 543 patients awaiting KT and 230 KT recipients were found to have biliary stones. Among the KT recipients, 16 (7%) underwent cholecystectomy before KT, while others chose to observe their biliary stones. Pre-KT cholecystectomy patients did not experience any biliary complications, and 20 (9.3%) patients who chose to observe their stones experienced complications. Those who underwent cholecystectomy before KT developed fewer postcholecystectomy complications (6.3%) compared with those who underwent cholecystectomy after KT (38.8%, P =0.042), including reduced occurrences of fatal postoperative complications based on the Clavien-Dindo classification. Multiple stones [odds ratio (OR), 3.09; 95% CI: 1.07-8.90; P =0.036), thickening of the gallbladder wall (OR, 5.39; 95% CI: 1.65-17.63; P =0.005), and gallstones >1 cm in size (OR 5.12, 95% CI: 1.92-13.69, P =0.001) were independent risk factors for biliary complications. Among patients awaiting KT, 23 (4.2%) underwent cholecystectomy during the follow-up, resulting in one postcholecystectomy complication. CONCLUSION Gallstone-related biliary complications following KT and subsequent cholecystectomy was associated with more serious complications and worse treatment outcomes. Therefore, when KT candidates had risk factor for biliary complications, pre-emptive cholecystectomy for asymptomatic cholecystolithiasis could be considered to reduce further surgical risk.
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Affiliation(s)
| | - Yunyoung Jang
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital
| | - Eunjeong Kang
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital
| | - Yong Chul Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital
| | - Sang Min
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | - Hajeong Lee
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital
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Revishvili AS, Olovyanny VE, Markov PV, Gurmikov BN, Kuznetsov AV. [Potentially preventable causes of mortality in acute calculous cholecystitis: a population-based study]. Khirurgiia (Mosk) 2024:5-15. [PMID: 39008693 DOI: 10.17116/hirurgia20240715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
OBJECTIVE To analyze potentially preventable causes of mortality from acute calculous cholecystitis (ACC) at the population level. MATERIAL AND METHODS A retrospective study of causes of ACC-related mortality was conducted. We used online survey of state hospitals and estimated fatal outcomes following ACC considering appropriate annual e-database. RESULTS There were 1.500 deaths among 142.975 patients aged ≥18 years with acute cholecystitis. We received responses to the proposed questionnaire about 1154 deaths (76.9%). Analysis included 648 cases of ACC (K80.0). Mean age of patients was 76.0 years (31-100). There were 256 (39.5%) men and 392 (60.5%) women. ACC severity was assessed according to the Tokyo guidelines (2018). Mild (I) degree was noted in 24 (3.7%) cases, moderate (II) - 270 (41.7%), severe (III) - 354 (54.6%) patients. Cardiovascular diseases and complications caused death in mild ACC regardless of treatment method in 16 (66.7%) cases, in moderate ACC - 106 (39.3%), in severe ACC - 97 (27.4%) cases. ACC caused death in 3 (12.5%) patients with mild disease, 111 (41.1%) with moderate disease and 200 (56.5%) ones with severe disease. Postoperative complications caused death in 4 (16.7%) patients with mild disease, 29 (10.7%) ones with moderate disease and 30 (8.5%) patients with severe disease. Other causes comprised 4.1% (n=1), 8.9% (n=24) and 7.6% (n=27), respectively. Potentially preventable causes of death were identified in 33.0% of cases. CONCLUSION ACC-related mortality is mainly associated with comorbidity in elderly and senile patients, late presentation and complicated course of disease. Delayed surgical treatment due to diagnostic and tactical problems, as well as technical intraoperative errors is potentially preventable causes of death.
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Affiliation(s)
- A Sh Revishvili
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - V E Olovyanny
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - P V Markov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - B N Gurmikov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A V Kuznetsov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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Rahimi R, Masoumi S, Badali A, Jafari N, Heidari-Soureshjani S, Sherwin CMT. Association Between Gallstone Disease and Risk of Mortality of Cardiovascular Disease and Cancer: A Systematic Review and Meta-Analysis. Cardiovasc Hematol Disord Drug Targets 2024; 24:47-58. [PMID: 38874034 DOI: 10.2174/011871529x298791240607041246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/30/2024] [Accepted: 05/17/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Gallstone disease (GD) is increasing in the world and has various complications. OBJECTIVE This study aims to examine the relationship between GD and the risk of mortality from cardiovascular disease (CVD) and cancer using a systematic review and meta-analysis approach. METHODS A comprehensive and systematic search was done in various databases, such as Web of Science (WOS), Scopus, MEDLINE/PubMed, Cochrane, and Embase. The search included studies published from 1980 to December 2023. Heterogeneity was assessed using Chi-square, I2, and forest plots, while publication bias was evaluated through Begg's and Egger's tests. All analyses were performed using Stata 15, with statistical significance set at p <0.05. RESULTS A pooled analysis of five studies involving 161,671 participants demonstrated that individuals with GD had a significantly higher risk of mortality from CVD (RR 1.29, 95% CI: 1.11-1.50, p <0.001). Importantly, no evidence of publication bias was found based on the results of Begg's test (p =0.806) and Egger's test (p =0.138). Furthermore, the pooled analysis of seven studies, encompassing a total of 562,625 participants, indicated an increased risk of cancer mortality among individuals with GD (RR 1.45, 95% CI: 1.16-1.82, p <0.001). Similarly, no publication bias was detected through Begg's test (p =0.133) and Egger's test (p =0.089). CONCLUSION In this study, the evidence of a significant association between GD and an elevated risk of mortality from CVD and canceris provided. These findings suggest that implementing targeted interventions for individuals with gallstone disease could reduce mortality rates among these patients.
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Affiliation(s)
- Rasoul Rahimi
- Department of Surgery, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Shahab Masoumi
- Cardiovascular Fellowship, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Cardiovascular Fellowship, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Ahmadreza Badali
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Negar Jafari
- Department of Cardiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Catherine M T Sherwin
- Pediatric Clinical Pharmacology and Toxicology, Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, One Children's Plaza, Dayton, Ohio, OH 45324, USA
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Fischer L, Halavach K, Huck B, Kolb G, Huber B, Segendorf C, Fischer E, Feißt M. [The clinical importance of the critical view of safety in laparoscopic cholecystectomy]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:544-549. [PMID: 36867210 PMCID: PMC9983532 DOI: 10.1007/s00104-023-01833-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Injury of the bile duct during cholecystectomy (CHE) is a severe complication. The critical view of safety (CVS) can help to reduce the frequency of this complication during laparoscopic CHE. So far, no scoring of CVS images with a grading system is available. METHOD The CVS images of 534 patients with laparoscopic CHE could be structurally analyzed and assessed with marks from 1 (very good) to 5 (insufficient). The CVS mark was correlated with the perioperative course. Additionally, the perioperative course of patients after laparoscopic CHE with and without a CVS image was investigated. RESULTS In 534 patients 1 or more CVS images could be analyzed. The average CVS mark was 1.9, whereby 280 patients (52.4%) had a 1, 126 patients (23.6%) a 2, 114 (21.3%) a 3 and 14 patients (2.6%) a 4 or 5. Younger patients with elective laparoscopic CHE had CVS images significantly more frequently (p ≤ 0.04). The statistical examination with Pearson's χ2-test and the F‑test (ANOVA) showed a significant correlation between improving CVS marks and reduction of surgery time (p < 0.01) and the hospitalization time (p < 0.01). For senior physicians the quota of CVS images ranged from 71% to 92% and the average marks from 1.5 to 2.2. The marks for the CVS images were significantly better for female than male patients (1.8 vs. 2.1, p < 0.01). DISCUSSION There was a relatively broad distribution of marks for CVS images. Injuries of the bile duct can be avoided with a high degree of certainty with marks 1‑2 for the CVS image. The CVS is not always adequately visualized in laparoscopic CHE.
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Affiliation(s)
- L. Fischer
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532 Baden-Baden, Deutschland
| | - K. Halavach
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532 Baden-Baden, Deutschland
| | - B. Huck
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532 Baden-Baden, Deutschland
| | - G. Kolb
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532 Baden-Baden, Deutschland
| | - B. Huber
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532 Baden-Baden, Deutschland
| | - C. Segendorf
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532 Baden-Baden, Deutschland
| | - E. Fischer
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532 Baden-Baden, Deutschland
| | - M. Feißt
- Institut für Medizinische Biometrie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130.3, 69121 Heidelberg, Deutschland
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Early cholecystectomy following percutaneous transhepatic gallbladder drainage is effective for moderate to severe acute cholecystitis in the octogenarians. Arch Gerontol Geriatr 2023; 106:104881. [PMID: 36470181 DOI: 10.1016/j.archger.2022.104881] [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: 09/02/2022] [Revised: 11/11/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute cholecystitis (AC) is a life-threatening infectious/inflammatory disease in older patients. This study aimed to investigate the safety and optimal timing of surgery in patients aged ≥ 80 years with moderate to severe AC who received percutaneous transhepatic gallbladder drainage (PTGBD). METHODS From January 2008 to February 2021, 152 patients were retrospectively enrolled. Clinical outcomes were compared among patients who received laparoscopic cholecystectomy (LC), open cholecystectomy (OC), and conversion surgery, and between those who received early (< 6 weeks after PTGBD) and delayed cholecystectomy (≥ 6 weeks after PTGBD). Logistic regression analysis was used to identify risk factors for recurrent AC, further biliary events, conversion, and perioperative complications. RESULTS Sixty-seven patients underwent LC, 62 underwent OC, and 23 underwent conversion surgery. Operation-related complications and mortality rates did not differ among the types of surgery; however, LC group had shorter operative time than the other groups. Eighty-two patients underwent early cholecystectomy, while 70 underwent delayed cholecystectomy. There were no differences in operative time, operation-related complications, and mortality rates between the groups. However, higher rates of recurrent AC and biliary events were observed in the delayed cholecystectomy group (52.9% vs. 4.9% and 57.1% vs. 8.5%, p < 0.001). On multivariate analysis, delayed cholecystectomy was a significant risk factor for recurrent AC (odds ratio [OR] = 19.42, p < 0.001) and further biliary events (OR = 15.95, p < 0.001). CONCLUSIONS Early cholecystectomy is recommended for patients aged ≥ 80 years with moderate to severe AC following PTGBD.
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Lee BJH, Yap QV, Low JK, Chan YH, Shelat VG. Cholecystectomy for asymptomatic gallstones: Markov decision tree analysis. World J Clin Cases 2022; 10:10399-10412. [PMID: 36312509 PMCID: PMC9602237 DOI: 10.12998/wjcc.v10.i29.10399] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/13/2022] [Accepted: 09/01/2022] [Indexed: 02/05/2023] Open
Abstract
Gallstones are a common public health problem, especially in developed countries. There are an increasing number of patients who are diagnosed with gallstones due to increasing awareness and liberal use of imaging, with 22.6%-80% of gallstone patients being asymptomatic at the time of diagnosis. Despite being asymptomatic, this group of patients are still at life-long risk of developing symptoms and complications such as acute cholangitis and acute biliary pancreatitis. Hence, while early prophylactic cholecystectomy may have some benefits in selected groups of patients, the current standard practice is to recommend cholecystectomy only after symptoms or complications occur. After reviewing the current evidence about the natural course of asymptomatic gallstones, complications of cholecystectomy, quality of life outcomes, and economic outcomes, we recommend that the option of cholecystectomy should be discussed with all asymptomatic gallstone patients. Disclosure of material information is essential for patients to make an informed choice for prophylactic cholecystectomy. It is for the patient to decide on watchful waiting or prophylactic cholecystectomy, and not for the medical community to make a blanket policy of watchful waiting for asymptomatic gallstone patients. For patients with high-risk profiles, it is clinically justifiable to advocate cholecystectomy to minimize the likelihood of morbidity due to complications.
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Affiliation(s)
- Brian Juin Hsien Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore S308232, Singapore
| | - Qai Ven Yap
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore S117597, Singapore
| | - Jee Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, Singapore S308433, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore S117597, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore S308433, Singapore
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Fischer L, Watrinet K, Kolb G, Segendorf C, Huber B, Huck B. Patienten* nach unauffälliger elektiver laparoskopischer Cholezystektomie können ohne Laborwertkontrollen entlassen werden – Ergebnisse einer prospektiven Studie. DIE CHIRURGIE 2022; 93:1089-1094. [PMID: 36083303 PMCID: PMC9461431 DOI: 10.1007/s00104-022-01713-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/25/2022]
Abstract
Hintergrund Die Bedeutung postoperativer Laborkontrollen nach elektiver laparoskopischer Cholezystektomie (lap. CHE) ist umstritten. Das Ziel dieser prospektiven Studie war es, herauszufinden, ob Patienten* bei unauffälligem perioperativem Verlauf nach lap. CHE ohne Laborwertkontrollen sicher entlassen werden können. Methodik Vom 09/20 bis 03/22 wurden alle Patienten* mit einer lap. CHE gescreent und nach Erhalt des Einverständnisses in die Studie eingeschlossen. Der Verlauf wurde mit einem Scoring- (Punktewert 3–15 Punkte) und Befragungsbogen strukturiert verfolgt. Ein Scoringwert von ≤ 9 Punkten beschrieb einen unauffälligen perioperativen Verlauf. Die Ethikkommission Heidelberg hat dieser Studie zugestimmt (S-026/2020). Ergebnisse Es wurden 275 Patienten* mit Gallenblasenoperation erfasst. Davon unterzogen sich 80 % einer elektiven lap. CHE. 56 Patienten* (25 %) wurden in die Studie eingeschlossen, 51 Patienten* wurden bei einem Scoringwert ≤ 9 Punkten ohne Blutentnahme entlassen. Das Durchschnittsalter der 51 Patienten* war 50,8 Jahre, der durchschnittliche Krankenhausaufenthalt betrug 2,6 Tage. 40 von 51 Patienten* (78,4 %) konnten postoperativ befragt werden. Bei keinem der Patienten* kam es nach Entlassung zu relevanten Komplikationen. 27 der 40 Patienten* (67,5 %) sind postoperativ noch einmal zum Hausarzt gegangen. Aufgrund anderer Operationen und einer endoskopischen Intervention sind 4 Patienten* erneut stationär behandelt worden. Alle Patienten* waren mit dem chirurgischen Verlauf zufrieden. Diskussion Patienten* mit unauffälligem perioperativem Verlauf nach elektiver lap. CHE (Scoringwert ≤ 9 Punkten) können ohne postoperative Laborwertkontrolle entlassen werden.
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Affiliation(s)
- L. Fischer
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Str. 50, 76532 Baden-Baden, Deutschland
| | - K. Watrinet
- Medizinische Fakultät, Universität Heidelberg, Heidelberg, Deutschland
| | - G. Kolb
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Str. 50, 76532 Baden-Baden, Deutschland
| | - C. Segendorf
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Str. 50, 76532 Baden-Baden, Deutschland
| | - B. Huber
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Str. 50, 76532 Baden-Baden, Deutschland
| | - B. Huck
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Str. 50, 76532 Baden-Baden, Deutschland
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Cholecystectomy after endoscopic sphincterotomy in elderly: A dilemma. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1115509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background/Aim: Although cholecystectomy is recommended by many guidelines after endoscopic retrograde cholangiopancreatography (ERCP) for gallstones, the necessity of cholecystectomy in geriatric patients is a matter of debate. Here we compare the outcomes of new biliary events in cholecystectomized and non-cholecystectomized patients of geriatric age after ERCP for suspected choledocholithiasis.
Methods: Non-cholecystectomized patients who underwent ERCP for choledocholithiasis from 2015 to 2017 were included in this retrospective cohort study. Patients with other biliary pathologies, incomplete clearance of common bile duct stones, and those who could not be reached at follow-up were excluded from the study. Biliary events (cholecystitis, cholangitis, pancreatitis, re-ERCP) were evaluated by considering age groups in patients with and without cholecystectomy in their follow-up after sphincterotomy.
Results: A total of 284 patients were followed for an average of 69.77 (0.2) months. The cumulative incidence of biliary events in cholecystectomized patients was lower (16% vs. 21.5%; P < 0.001), and cholecystectomized patients had a longer time to the occurrence of events (mean 74.49 [0.27] months vs. 73.50 [0.33] months; P = 0.03). There was no significant difference in the frequency of biliary events between elderly patients with and without cholecystectomy (P = 0.81), and the cumulative incidence of biliary events in the in situ group was significantly lower than that in the geriatric group (17.5% vs 32.6%; P = 0.03)
Conclusion: Although cholecystectomy significantly reduces subsequent biliary complications in young patients, it does not provide a statistically significant benefit in geriatric patients. We believe that there may be no need for routine prophylactic cholecystectomy after endoscopic sphincterotomy in geriatric patients.
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Fischer L, Kolb G, Segendorf C, Huber B, Watrinet K, Horoba L, Huck B, Schultze D. [Which patient needs controls of laboratory values after elective laparoscopic cholecystectomy?-Can a score help?]. Chirurg 2021; 92:369-373. [PMID: 32757046 DOI: 10.1007/s00104-020-01258-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy is nearly exclusively carried out as an inpatient operation in Germany. The aim of the study was to evaluate for which patients postoperative laboratory control values are necessary. METHODS This retrospective analysis included 100 patients who underwent elective laparoscopic cholecystectomy. A scoring and data collection sheet was developed, which enables a risk stratification. Using the scoring system patients can achieve between 3 and 15 points. RESULTS In total 100 patients were included in the study. Of the patients 64 (group 1) had between 3 and 8 points, 29 patients (group 2) between 9 and 11 points and 7 patients (group 3) between 12 and 15 points. In comparison to group 1 the C‑reactive protein values as well as the duration of hospital stay were significantly increased in group 2 and group 3 (p > 0.05). In group1 a total of 60 patients (93.7%) were discharged regularly on postoperative days 1-3. In group 2 there were 17 patients (58.6%) who could be discharged with unremarkable blood values and in group 3 there were 3 patients (42.8%). In the total collective hospital discharge without a laboratory control of blood values would have been justified in 80% of the patients. CONCLUSION A postoperative control of laboratory blood values is not routinely necessary for patients after elective laparoscopic cholecystectomy with a score <9 points.
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Affiliation(s)
- L Fischer
- Abteilung für Allgemein‑, Viszeral- und Thoraxchirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532, Baden-Baden, Deutschland.
| | - G Kolb
- Abteilung für Allgemein‑, Viszeral- und Thoraxchirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532, Baden-Baden, Deutschland
| | - C Segendorf
- Abteilung für Allgemein‑, Viszeral- und Thoraxchirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532, Baden-Baden, Deutschland
| | - B Huber
- Abteilung für Allgemein‑, Viszeral- und Thoraxchirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532, Baden-Baden, Deutschland
| | - K Watrinet
- Abteilung für Allgemein‑, Viszeral- und Thoraxchirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532, Baden-Baden, Deutschland
| | - L Horoba
- Abteilung für Allgemein‑, Viszeral- und Thoraxchirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532, Baden-Baden, Deutschland
| | - B Huck
- Abteilung für Allgemein‑, Viszeral- und Thoraxchirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532, Baden-Baden, Deutschland
| | - D Schultze
- Abteilung für Allgemein‑, Viszeral- und Thoraxchirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532, Baden-Baden, Deutschland
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Escalante Arbeláez D, Bernal Gutiérrez M, Buitrago Gutiérrez G. Mortalidad perioperatoria y volumen quirúrgico de colecistectomías en el régimen contributivo en Colombia. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Introducción. La patología biliar es una causa frecuente de intervención quirúrgica, Pero en Colombia no se cuenta con datos oficiales de mortalidad ni volumen quirúrgico asociados a este procedimiento.
El objetivo de este estudio fue determinar el volumen de colecistectomías y describir la tasa general de mortalidad perioperatoria en seis regiones geográficas del país, en el periodo de 2012 a 2016.
Métodos. Estudio de cohortes retrospectivo que incluyó pacientes mayores de 18 años, afiliados al régimen contributivo de salud, llevados a colecistectomía. Se utilizó la base de datos de suficiencia de la Unidad de Pago por Capitación (UPC), la base de estadísticas vitales del Departamento Administrativo Nacional de Estadística (DANE) y la del Sistema Integrado de Información de la Protección Social (SISPRO).
Resultados. Durante el periodo de estudio, se realizaron 192.080 colecistectomías, lo que corresponde a 206 colecistectomías por 100.000 habitantes. Se encontró mayor volumen quirúrgico en personas entre los 65 y 80 años, en el sexo femenino y en la ciudad de Bogotá. La mortalidad perioperatoria encontrada correspondió al 0,6 %, siendo mayor en los pacientes de sexo masculino, de edad avanzada, en aquellos en quienes se practicó laparotomía y en los pacientes operados en la ciudad de Bogotá.
Discusión. De acuerdo con los hallazgos, esta investigación puede servir de base para estudios posteriores, que muestren claramente las cifras oficiales de volumen quirúrgico y de mortalidad por colecistectomía en Colombia.
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Syrén EL, Enochsson L, Eriksson S, Eklund A, Isaksson B, Sandblom G. Cardiovascular complications after common bile duct stone extractions. Surg Endosc 2020; 35:3296-3302. [PMID: 32613302 PMCID: PMC8195933 DOI: 10.1007/s00464-020-07766-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Common bile duct stone (CBDS) is a common condition the rate of which increases with age. Decision to treat in particular elderly and frail patients with CBDS is often complex and requires careful assessment of the risk for treatment-related cardiovascular complications. The aim of this study was to compare the rate of postoperative cardiovascular events in CBDS patients treated with the following: ERCP only; cholecystectomy only; cholecystectomy followed by delayed ERCP; cholecystectomy together with ERCP; or ERCP followed by delayed cholecystectomy. METHODS The study was based on data from procedures for gallstone disease registered in the Swedish National Quality Register for Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (GallRiks) 2006-2014. ERCP and cholecystectomy procedures performed for confirmed or suspected CBDS were included. Postoperative events were registered by cross-matching GallRiks with the National Patient Register (NPR). A postoperative cardiovascular event was defined as an ICD-code in the discharge notes indicating myocardial infarct, pulmonary embolism or cerebrovascular disease within 30 days after surgery. In cases where a patient had undergone ERCP and cholecystectomy on separate occasions, the 30-day interval was timed from the first intervention. RESULTS A total of 23,591 underwent ERCP or cholecystectomy for CBDS during the study period. A postoperative cardiovascular event was registered in 164 patients and death within 30 days in 225 patients. In univariable analysis, adverse cardiovascular event and death within 30 days were more frequent in patients who underwent primary ERCP (p < 0.05). In multivariable analysis, adjusting for history of cardiovascular disease or events, neither risk for cardiovascular complication nor death within 30 days remained statistically significant in the ERCP group. CONCLUSIONS Primary ERCP as well as cholecystectomy may be performed for CBDS with acceptable safety. More studies are required to provide reliable guidelines for the management of CBDS.
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Affiliation(s)
- Eva-Lena Syrén
- Department of Surgical Sciences, Uppsala University, 751 35, Uppsala, Sweden. .,Centre for Clinical Research, Västmanland Hospital, Västerås, Sweden.
| | - Lars Enochsson
- Department of Surgical and Perioperative Sciences, Sunderby Research Unit, Umeå University, SurgeryUmeå, Sweden
| | - Staffan Eriksson
- Department of Surgical Sciences, Uppsala University, 751 35, Uppsala, Sweden.,Centre for Clinical Research, Västmanland Hospital, Västerås, Sweden
| | - Arne Eklund
- Department of Surgical Sciences, Uppsala University, 751 35, Uppsala, Sweden.,Centre for Clinical Research, Västmanland Hospital, Västerås, Sweden
| | - Bengt Isaksson
- Department of Surgical Sciences, Uppsala University, 751 35, Uppsala, Sweden
| | - Gabriel Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
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Wu PS, Chou CK, Hsieh YC, Chen CK, Lin YT, Huang YH, Hou MC, Lin HC, Lee KC. Antibiotic use in patients with acute cholecystitis after percutaneous cholecystostomy. J Chin Med Assoc 2020; 83:134-140. [PMID: 31868860 DOI: 10.1097/jcma.0000000000000244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Currently, evidence regarding the strategies of antibiotic use in patients with acute cholecystitis after receiving percutaneous cholecystostomy is limited. Hence, we aimed to investigate the outcomes in patients with inoperable acute cholecystitis receiving narrow or broad-spectrum antibiotics after percutaneous cholecystostomy. METHODS A total of 117 patients receiving percutaneous cholecystostomy were categorized into moderate and severe acute cholecystitis defined by the Tokyo guideline and then divided into group A (narrow-spectrum antibiotic use) and group B (broad-spectrum antibiotic use). The clinical outcomes and complications were analyzed. RESULTS In moderate acute cholecystitis (n = 80), group A patients (n = 62) had similar early recurrent rate (11.3% vs 16.7%; p = 0.544) and a shorter length of hospital stay (13.4 ± 8.6 vs 18.6 ± 9.4 days; p = 0.009) as compared with group B patients (n = 18). No in-hospital mortality occurred in moderate acute cholecystitis. In severe acute cholecystitis (n = 37), both groups had similar length of hospital stay (16.3 ± 12.2 vs 20.9 ± 9.5 days; p = 0.051), early recurrent rate (0% vs 16.7%; p = 0.105), and in-hospital mortality rate (5.3% vs 16.7%; p = 0.340). Although group B patients with severe cholecystitis had higher serum levels of alkaline phosphatase (Alk-P) and higher proportion of underlying malignancy, American Society of Anesthesiologists (ASA) class IV and septic shock, the clinical outcomes were not inferior to patients in group A. CONCLUSION In moderate acute cholecystitis after percutaneous cholecystostomy, patients receiving narrow-spectrum antibiotics have comparable clinical outcomes as those treated with broad-spectrum antibiotics. However, in severe acute cholecystitis, broad-spectrum antibiotics might still be necessary to rescue these patients.
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Affiliation(s)
- Pei-Shan Wu
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chung-Kai Chou
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Division of Gastroenterology, Department of Medicine, National Yang-Ming University Hospital, Ilan, Taiwan, ROC
| | - Yun-Chen Hsieh
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chun-Ku Chen
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Tsung Lin
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Kuei-Chuan Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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Gurusamy KS, Davidson BR. Gallstone Disease. EVIDENCE‐BASED GASTROENTEROLOGY AND HEPATOLOGY 4E 2019:342-352. [DOI: 10.1002/9781119211419.ch22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Nassar Y, Richter S. Management of complicated gallstones in the elderly: comparing surgical and non-surgical treatment options. Gastroenterol Rep (Oxf) 2019; 7:205-211. [PMID: 31217985 PMCID: PMC6573799 DOI: 10.1093/gastro/goy046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 08/07/2018] [Accepted: 08/13/2018] [Indexed: 02/06/2023] Open
Abstract
Objective The aim of this study was to evaluate the differences in clinical outcomes of endoscopic retrograde cholangiopancreatography (ERCP), ERCP followed by cholecystectomy (EC) and percutaneous aspiration (PA) in the elderly population with choledocholithiasis. Methods We included a total of 43 338 elderly patients aged 60 years or older and 45 295 patients younger than 60 years for comparison in our study. Data were obtained from the Nationwide Inpatient Sample (Healthcare Utilization Project) for years 2001–14 by identifying patients who were admitted for gallstone complications based on the ICD 9 diagnostic code. Multiple logistic regression was used to calculate the odds of in-hospital mortality and to detect statistical differences among the treatment groups, age groups and between male and female patients. Univariate ordinary linear regression was used to compare the length of hospital stay and readmission frequency among the different age groups. Results The age of the patient affected mortality and the length of hospital stay after any type of procedure of gallstones removal. In a manner independent of the patient’s age, PA was associated with the highest risk of death and length of stay, while the EC was characterized by lowest mortality and ERCP by the shortest length of stay. Neither age of the patient nor the type of procedure affected the likelihood of readmission. The odds of death and the probability of readmission were not affected by patient sex. However, in patients aged between 60 and 79 years, the female gender predicted a shorter duration of stay in the hospital. Conclusions A patient’s age negatively affects the treatment outcomes of cholelithiasis with associated complications. The EC procedure appears to be the method of choice for the management of complicated gallstones in patients of all ages.
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Affiliation(s)
- Yousef Nassar
- Department of Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, USA
| | - Seth Richter
- Division of Gastroenterology, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, USA
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Terho PM, Leppäniemi AK, Mentula PJ. Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications. World J Emerg Surg 2016; 11:54. [PMID: 27891173 PMCID: PMC5112701 DOI: 10.1186/s13017-016-0111-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/11/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The purpose of the study was to identify risk factors for conversion of laparoscopic cholecystectomy and risk factors for postoperative complications in acute calculous cholecystitis. The most common complications arising from cholecystectomy were also to be identified. METHODS A total of 499 consecutive patients, who had undergone emergent cholecystectomy with diagnosis of cholecystitis in Meilahti Hospital in 2013-2014, were identified from the hospital database. Of the identified patients, 400 had acute calculous cholecystitis of which 27 patients with surgery initiated as open cholecystectomy were excluded, resulting in 373 patients for the final analysis. The Clavien-Dindo classification of surgical complications was used. RESULTS Laparoscopic cholecystectomy was initiated in 373 patients of which 84 (22.5%) were converted to open surgery. Multivariate logistic regression identified C-reactive protein (CRP) over 150 mg/l, age over 65 years, diabetes, gangrene of the gallbladder and an abscess as risk factors for conversion. Complications were experienced by 67 (18.0%) patients. Multivariate logistic regression identified age over 65 years, male gender, impaired renal function and conversion as risk factors for complications. CONCLUSIONS Advanced cholecystitis with high CRP, gangrene or an abscess increase the risk of conversion. The risk of postoperative complications is higher after conversion. Early identification and treatment of acute calculous cholecystitis might reduce the number of patients with advanced cholecystitis and thus improve outcomes.
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Affiliation(s)
- Petra Maria Terho
- Institute of Clinical Medicine, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00014 Helsinki, Finland
| | - Ari Kalevi Leppäniemi
- Department of Abdominal Surgery, Helsinki University Central Hospital, P.O.Box 340, 00029 HUS Helsinki, Finland
| | - Panu Juhani Mentula
- Department of Abdominal Surgery, Helsinki University Central Hospital, P.O.Box 340, 00029 HUS Helsinki, Finland
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Ukkonen M, Kivivuori A, Rantanen T, Paajanen H. Emergency Abdominal Operations in the Elderly: A Multivariate Regression Analysis of 430 Consecutive Patients with Acute Abdomen. World J Surg 2015; 39:2854-61. [PMID: 26304610 DOI: 10.1007/s00268-015-3207-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
OBJECTIVE This article outlines the formation of the Australian and New Zealand Audit of Surgical Mortality (ANZASM) and describes its objectives, governance, functioning and challenges. BACKGROUND A nationwide audit of surgical mortality provides an overview of the leading causes of death in patients who require surgical care. It identifies system or process errors, trends in deficiency of care and helps develop strategies to reduce deaths in the surgical arena. METHODS A standardized tool is used to systematically collect data after every surgical death. Patient details are reviewed by a peer surgeon (and in certain cases a second) to identify issues with patient management and hospital processes. The treating surgeon is then offered confidential feedback and alternate views on patient management. RESULTS From January 2009 to December 2012, 19,096 deaths were reported to the ANZASM. Eighty-six percent of the audited deaths occurred in patients requiring an emergency admission. Significant criticism of patient care was reported in 13% of cases with 16% of clinical issues perceived to be preventable. Western Australia, which first began the audit process, has shown a 30% reduction in surgical deaths. CONCLUSIONS Nationwide mortality audits are a useful and worthwhile exercise. Recommendations identified in the audit reports direct educational workshops and seminars to address these issues. They allow Departments of Health to make informed decisions in their hospitals. Through this model, and the lessons learnt, we would encourage other countries planning to set up their own audits to follow a similar concept.
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Sandblom G, Videhult P, Crona Guterstam Y, Svenner A, Sadr-Azodi O. Mortality after a cholecystectomy: a population-based study. HPB (Oxford) 2015; 17:239-243. [PMID: 25363135 PMCID: PMC4333785 DOI: 10.1111/hpb.12356] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 09/22/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The trade-off between the benefits of surgery for gallstone disease for a large population and the risk of lethal outcome in a small minority requires knowledge of the overall mortality. METHODS Between 2007 and 2010, 47 912 cholecystectomies for gallstone disease were registered in the Swedish Register for Cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) (GallRiks). By linkage to the Swedish Death Register, the 30-day mortality after surgery was determined. The age- and sex-standardized mortality ratio (SMR) was estimated by dividing the observed mortality with the expected mortality rate in the Swedish general population 2007. The Charlson Comorbidity Index (CCI) was estimated by International Classification of Diseases (ICD) codes retrieved from the National Patient Register. RESULTS Within 30 days after surgery, 72 (0.15%) patients died. The 30-day mortality was close [SMR = 2.58; 95% confidence interval (CI): 2.02-3.25] to that of the Swedish general population. In multivariable logistic regression analysis, predictors of 30-day mortality were age >70 years [odds ratio (OR) 7.04, CI: 2.23-22.26], CCI > 2 (OR 1.93, CI: 1.06-3.51), American Society of Anesthesiologists (ASA) > 2 (OR 13.28, CI: 4.64-38.02), acute surgery (OR 10.05, CI:2.41-41.95), open surgical approach (OR 2.20, CI: 1.55-4.69) and peri-operative complications (OR 3.27, CI: 1.74-6.15). DISCUSSION Mortality after cholecystectomy is low. Co-morbidity and peri-operative complications may, however, increase mortality substantially. The increased mortality risk associated with open cholecystectomy could be explained by confounding factors influencing the decision to perform open surgery.
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Affiliation(s)
- Gabriel Sandblom
- Division of Surgery, Institution of Clinical Sciences, Intervention and Technology, Karolinska InstituteStockholm, Sweden
| | - Per Videhult
- Department of Surgery, Västerås HospitalVästerås, Sweden
| | | | - Annika Svenner
- Division of Surgery, Institution of Clinical Sciences, Intervention and Technology, Karolinska InstituteStockholm, Sweden
| | - Omid Sadr-Azodi
- Division of Surgery, Institution of Clinical Sciences, Intervention and Technology, Karolinska InstituteStockholm, Sweden
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Suuronen S, Niskanen L, Paajanen P, Paajanen H. Declining cholecystectomy rate during the era of statin use in Finland: a population-based cohort study between 1995 and 2009. Scand J Surg 2015; 102:158-63. [PMID: 23963029 DOI: 10.1177/1457496913492463] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Aging with comorbidities, obesity, and rapid recovery from operation may increase the need for laparoscopic cholecystectomy, but long-term use of statins may be associated with a decreased risk of gallstones. This population-based cohort study presents the changing rate and causative factors of laparoscopic cholecystectomy in Finland during the era of statin use. MATERIALS AND METHODS Age structure of the population, changes in body mass index and diabetes, and the number of all cholecystectomies in 1995-2009 were retrieved from the registers of National Institute for Health and Welfare. Additionally, these results were supplemented by a population-based retrospective cohort (1581 laparoscopic cholecystectomy) in one community-based hospital area. The risk factors for laparoscopic cholecystectomy, use of statins, and surgical outcome were analyzed. RESULTS During the 15 years, 123,794 cholecystectomies were performed in Finland, of which 94,740 (76.5%) were performed using laparoscopic technique. The median rate of laparoscopic cholecystectomy varied between 110 and 140 operations per 100,000 inhabitants. In 1995-2009, the annual number of cholecystectomies decreased from 8600 to 7500, the number of laparoscopic cholecystectomies increased by 10%, and the number of open cholecystectomies declined by 60%. In a cohort of 1581 laparoscopic cholecystectomies, the proportion of elderly (>65 years of age), obese (body mass index > 30 kg/m(2)), and diabetic patients increased from 17% to 28%, 9% to 34%, and 4% to 8%, respectively. Use of statins increased more than fourfold during the 15 years. CONCLUSIONS The rates of all cholecystectomies decreased despite marked increase in laparoscopic cholecystectomies performed. The increase in risk factors for gallstones in Finland implied more marked increase in laparoscopic cholecystectomies. The possible role of statins on gallstone disease is discussed.
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Affiliation(s)
- S Suuronen
- Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland
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Evaluation of modified estimation of physiologic ability and surgical stress in patients undergoing surgery for choledochocystolithiasis. World J Surg 2014; 38:1177-83. [PMID: 24322176 DOI: 10.1007/s00268-013-2383-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The incidence of complicated choledochocystolithiasis is increasing with the aging of society in Japan. We evaluated the utility of our prediction rule modified estimation of physiologic ability and surgical stress (mE-PASS) in predicting postoperative adverse events in patients with choledochocystolithiasis. METHODS A total of 4,329 patients who underwent elective surgery for choledochocystolithiasis in 44 referral hospitals between April 1987 and April 2007 were analyzed for mE-PASS along with postoperative events. The discrimination power of mE-PASS was assessed by the area under the receiver operating characteristic curve (AUC). The correlation between ordinal and interval variables was quantified by the Spearman rank correlation (ρ). The ratio of observed-to-estimated mortality rates (OE ratio) was used as a metric of surgical quality. RESULTS Postoperative in-hospital mortality rates were 0 % (0/3,442) for laparoscopic cholecystectomy, 0.19 % (1/521) for open cholecystectomy, 1.6 % (1/63) for laparoscopic choledochotomy, 1.1 % (3/264) for open choledochotomy, and 5.1 % (2/39) for plasty or resection of the common bile duct. mE-PASS demonstrated a high discrimination power to predict in-hospital mortality; AUC, 95 % confidence interval (CI) of 0.96, 0.94-0.99. The predicted mortality rates significantly correlated with the severity of postoperative complications (ρ = 0.278, p < 0.0001) and length of hospital stay (ρ = 0.479, p < 0.0001). The OE ratios (95 % CI) improved slightly over time; 1.5 (0.25-9.0) between 1987 and 2000, and 0.40 (0.078-2.1) between 2001 and 2007. CONCLUSIONS The present study suggests that mE-PASS can predict postoperative risks in patients who have undergone choledochocystolithiasis. mE-PASS may be useful in surgical decision making and evaluating the quality of care.
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Parmar AD, Coutin MD, Vargas GM, Tamirisa NP, Sheffield KM, Riall TS. Cost-effectiveness of elective laparoscopic cholecystectomy versus observation in older patients presenting with mild biliary disease. J Gastrointest Surg 2014; 18:1616-22. [PMID: 24919433 PMCID: PMC4140946 DOI: 10.1007/s11605-014-2570-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/02/2014] [Indexed: 01/31/2023]
Abstract
Our objective was to determine the probability threshold for recurrent symptoms at which elective cholecystectomy compared to observation in older patients with symptomatic cholelithiasis is the more effective and cost-effective option. We built a decision model of elective cholecystectomy versus observation in patients >65 presenting with initial episodes of symptomatic cholelithiasis that did not require initial hospitalization or cholecystectomy. Probabilities for subsequent hospitalization, emergency cholecystectomy, and perioperative complications were based on previously published probabilities from a 5 % national sample of Medicare patients. Costs were estimated from Medicare reimbursements and from the Healthcare Cost and Utilization Project. Utilities (quality-adjusted life years, QALYs) were obtained from established literature estimates. Elective cholecystectomy compared to observation in all patients was associated with lower effectiveness (-0.10 QALYs) and had an increased cost of $3,422.83 per patient at 2-year follow-up. Elective cholecystectomy became the more effective option when the likelihood for continued symptoms exceeded 45.3 %. Elective cholecystectomy was both more effective and less costly when the probability for continued symptoms exceeded 82.7 %. An individualized shared decision-making strategy based on these data can increase elective cholecystectomy rates in patients at high risk for recurrent symptoms and minimize unnecessary cholecystectomy for patients unlikely to benefit.
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Affiliation(s)
- Abhishek D. Parmar
- Departments of Surgery, The University of Texas Medical Branch, Galveston, Texas,The University of California, San Francisco-East Bay, Oakland, California
| | - Mark D. Coutin
- Departments of Surgery, The University of Texas Medical Branch, Galveston, Texas
| | - Gabriela M. Vargas
- Departments of Surgery, The University of Texas Medical Branch, Galveston, Texas
| | - Nina P. Tamirisa
- Departments of Surgery, The University of Texas Medical Branch, Galveston, Texas,The University of California, San Francisco-East Bay, Oakland, California
| | - Kristin M. Sheffield
- Departments of Surgery, The University of Texas Medical Branch, Galveston, Texas
| | - Taylor S. Riall
- Departments of Surgery, The University of Texas Medical Branch, Galveston, Texas
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Vaughan J, Nagendran M, Cooper J, Davidson BR, Gurusamy KS, Cochrane Anaesthesia Group. Anaesthetic regimens for day-procedure laparoscopic cholecystectomy. Cochrane Database Syst Rev 2014; 2014:CD009784. [PMID: 24464771 PMCID: PMC10518899 DOI: 10.1002/14651858.cd009784.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Day surgery involves admission of selected patients to hospital for a planned surgical procedure with the patients returning home on the same day. An anaesthetic regimen usually involves a combination of an anxiolytic, an induction agent, a maintenance agent, a method of maintaining the airway (laryngeal mask versus endotracheal intubation), and a muscle relaxant. The effect of anaesthesia may continue after the completion of surgery and can delay discharge. Various regimens of anaesthesia have been suggested for day-procedure laparoscopic cholecystectomy. OBJECTIVES To compare the benefits and harms of different anaesthetic regimens (risks of mortality and morbidity, measures of recovery after surgery) in patients undergoing day-procedure laparoscopic cholecystectomy. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 10, 2013), MEDLINE (PubMed) (1987 to November 2013), EMBASE (OvidSP) (1987 to November 2013), Science Citation Index Expanded (ISI Web of Knowledge) (1987 to November 2013), LILACS (Virtual Health Library) (1987 to November 2013), metaRegister of Controlled Trials (http://www.controlled-trials.com/mrct/) (November 2013), World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) portal (November 2013), and ClinicalTrials.gov (November 2013). SELECTION CRITERIA We included randomized clinical trials comparing different anaesthetic regimens during elective day-procedure laparoscopic cholecystectomy (irrespective of language or publication status). DATA COLLECTION AND ANALYSIS Two authors independently assessed trials for inclusion and independently extracted the data. We calculated the risk ratio, rate ratio or mean difference with 95% confidence intervals based on intention-to-treat or available data analysis. MAIN RESULTS We included 11 trials involving 1069 participants at low anaesthetic risk. The sample size varied from 40 to 300 participants. We included 23 comparisons. All trials were at a high risk of bias. We were unable to perform a meta-analysis because there were no two trials involving the same comparison. Primary outcomes included perioperative mortality, serious morbidity and proportion of patients who were discharged on the same day. There were no perioperative deaths or serious adverse events in either group in the only trial that reported this information (0/60). There was no clear evidence of a difference in the proportion of patients who were discharged on the same day between any of the comparisons. Overall, 472/554 patients (85%) included in this review were discharged as day-procedure laparoscopic cholecystectomy patients. Secondary outcomes included hospital readmissions, health-related quality of life, pain, return to activity and return to work. There was no clear evidence of a difference in hospital readmissions within 30 days in the only comparison in which this outcome was reported. One readmission was reported in the 60 patients (2%) in whom this outcome was assessed. Quality of life was not reported in any of the trials. There was no clear evidence of a difference in the pain intensity, measured by a visual analogue scale, between comparators in the only trial which reported the pain intensity at between four and eight hours after surgery. Times to return to activity and return to work were not reported in any of the trials. AUTHORS' CONCLUSIONS There is currently insufficient evidence to conclude that one anaesthetic regimen for day-procedure laparoscopic cholecystectomy is to be preferred over another. However, the data are sparse (that is, there were few trials under each comparison and the trials had few participants) and further well designed randomized trials at low risk of bias and which are powered to measure differences in clinically important outcomes are necessary to determine the optimal anaesthetic regimen for day-procedure laparoscopic cholecystectomy, one of the commonest procedures performed in the western world.
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Affiliation(s)
- Jessica Vaughan
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryLondonUKNW3 2QG
| | - Myura Nagendran
- Department of SurgeryUCL Division of Surgery and Interventional Science9th Floor, Royal Free HospitalPond StreetLondonUKNW3 2QG
| | - Jacqueline Cooper
- Royal Free HospitalDepartment of AnaesthesiaPond StreetLondonUKNW3 2QG
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryLondonUKNW3 2QG
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Laparoscopic cholecystectomy performed by residents: a retrospective study on 569 patients. Surg Res Pract 2014; 2014:912143. [PMID: 25379566 PMCID: PMC4208583 DOI: 10.1155/2014/912143] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/20/2013] [Indexed: 01/04/2023] Open
Abstract
Introduction. Aim of this study was to evaluate the safety of laparoscopic cholecystectomy performed by residents.
Materials and Methods. We retrospectively reviewed 569 elective laparoscopic cholecystectomies. Results. Duration of surgery was 84 ± 39 min for residents versus 66 ± 47 min for staff surgeons, P < 0.001. Rate of conversion was 3.2% for residents versus 2.7% for staff surgeons, P = 0.7. There was no difference in the rates of intraoperative and postoperative complications for residents (1.2% and 3.2%) versus staff surgeons (1.5% and 3.1%), P = 0.7 and P = 0.9. Postoperative hospital stay was 3.3 ± 1.8 days for residents versus 3.4 ± 3.2 days for staff surgeons, P = 0.6. One death in patients operated by residents (1/246) and one in patients operated by staff surgeons (1/323) were found, P = 0.8. No difference in the time to return to normal daily activities between residents (11.3 ± 4.2 days) and staff surgeons (10.8 ± 5.6 days) was found, P = 0.2. Shorter duration of surgery when operating the senior residents (75 ± 31 minutes) than the junior residents (87 ± 27 minutes), P = 0.003. Conclusion. Laparoscopic cholecystectomy performed by residents is a safe procedure with results comparable to those of staff surgeons.
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White RD, Ingram S, Moss JG, Pace N, Chakraverty S. Mortality reporting in interventional radiology: experience of a pilot audit with the Scottish Audit of Surgical Mortality. Clin Radiol 2013; 68:1065-9. [PMID: 23810694 DOI: 10.1016/j.crad.2013.05.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/28/2013] [Accepted: 05/08/2013] [Indexed: 01/04/2023]
Abstract
AIM To describe the initial pilot phase of the 2009 Scottish Audit of Surgical Mortality (SASM), which includes outcomes and difficulties that arose during any interventional radiology (IR) procedure performed on patients in this audit over an 18 month period. MATERIALS AND METHODS Approximately 40 consultant interventional radiologists from all units in Scotland elected to participate in the audit. Each response was then peer reviewed after anonymisation of the patient and institution. If a relevant ACON (area for consideration or area of concern) was generated, this was checked by one of the other reviewers before communication with the original reporting radiologist and colleagues. There was then a right of reply by the reporting unit before formal documentation was sent out. RESULTS Initial results were analysed after 18 months period, during which time 95 forms relating to deaths of surgical inpatients were sent to interventional radiologists identified as having been involved in an IR procedure at some time during the patient's admission. Seventy-one forms had been returned by July 2010, of which 46 had gone through the entire SASM process. From these, 10 ACONs were attributed. Anonymised case vignettes and reports from these were used as educational tools. CONCLUSION Involvement with SASM is a useful process. Significant safety issues and learning points were identified in the pilot. The majority of ACONs identified by the audit were in patients who had undergone percutaneous biliary interventions.
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Affiliation(s)
- R D White
- Department of Radiology, Ninewells Hospital, Dundee, UK
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McKay A, Katz A, Lipschitz J. A population-based analysis of the morbidity and mortality of gallbladder surgery in the elderly. Surg Endosc 2013; 27:2398-406. [PMID: 23443477 DOI: 10.1007/s00464-012-2746-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 12/04/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND Historically, emergency gallbladder surgery in elderly patients has been associated with high rates of morbidity and mortality. Recent studies have described much lower complication rates that may still overestimate morbidity. The purpose of this study was to determine the true population morbidity and mortality rates after gallbladder surgery in the elderly. METHODS All elderly patients (defined as age 65 years or older) admitted to the hospital with a principle diagnosis related to benign gallbladder disease in the Province of Manitoba from January 1, 1995 to December 31, 2008 were identified by using administrative claims data. Outcomes after emergency gallbladder surgery, including complication rates and their predictors, were compared with outcomes after elective surgery and after nonoperative treatment for gallbladder-related hospital admissions. RESULTS A total of 9,936 patients were included: 2,355 had emergency or urgent surgery and 4,901 had elective procedures, whereas 2,680 patients were treated without surgery. Emergency gallbladder surgery was associated with a mortality rate of 0.7 %, compared with 1.6 % for elective cases and 5.6 % for patients treated nonoperatively. Complication rates were 16.2, 17.7, and 25 % respectively. Independent predictors of 30-day mortality were age, male gender, increasing comorbidity, surgeon experience, and surgical treatment. CONCLUSIONS Emergency gallbladder surgery in the elderly was not associated with higher mortality or complication rate compared with the elective setting. Elderly patients with gallbladder-related emergencies should be offered urgent surgery when feasible.
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Affiliation(s)
- Andrew McKay
- Department of Surgery, Health Sciences Centre, University of Manitoba, GF-431, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada.
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Schmidt M, Småstuen MC, Søndenaa K. Increased cancer incidence in some gallstone diseases, and equivocal effect of cholecystectomy: a long-term analysis of cancer and mortality. Scand J Gastroenterol 2012; 47:1467-74. [PMID: 22946484 DOI: 10.3109/00365521.2012.719928] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Our aim was to investigate cancer incidence and the cause of long-term mortality in different gallstone diseases and conditions. STUDY DESIGN The study population consisted of 2034 subjects: 224 persons diagnosed with asymptomatic gallstones in 1983, 254 patients who underwent cholecystectomy in 1983, and 513 patients with symptomatic uncomplicated gallstones (SGS, n = 337) or acute cholecystitis (AC, n = 176) between 1992 and 1994. One thousand and forty-three people who participated in a population study in 1983 were controls. RESULTS An overall increased risk of cancer, as well as higher mortality, was found among persons with asymptomatic gallstones compared to controls (HR 1.46, 95% CI: 1.06-2.00 and HR 1.39, 95% CI: 1.08-1.78), whereas patients who underwent cholecystectomy in 1983 showed a slightly higher risk (not significant) for both cancer and death than controls. Among patients with SGS from 1992 to 1994 there was a significantly higher risk of contracting cancer in patients who had undergone surgery (HR = 2.56, 95% CI: 1.13-5.83). For patients with AC, there was no significant difference between surgically treated and non-surgically treated subjects, but there was a higher risk of cancer in all AC compared to SGS patients (HR 2.03, 95% CI: 1.20-3.43). Mortality did not differ significantly between surgically treated and non-surgically treated patients with SGS or AC. CONCLUSION Gallstone patients had a greater risk than the general population for developing cancer, but this was dependent on the type of gallstone condition and treatment. The effect of cholecystectomy seemed dubious.
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Gurusamy KS, Cooper J, Davidson BR. Anaesthetic regimens for day-procedure laparoscopic cholecystectomy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Fahrner R, Turina M, Neuhaus V, Schöb O. Laparoscopic cholecystectomy as a teaching operation: comparison of outcome between residents and attending surgeons in 1,747 patients. Langenbecks Arch Surg 2011; 397:103-10. [PMID: 22012582 DOI: 10.1007/s00423-011-0863-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 10/10/2011] [Indexed: 12/17/2022]
Abstract
PURPOSE Standardized surgical training is increasingly confronted with the public demand for high quality of surgical care in modern teaching hospitals. The aim of this study was to compare the results of laparoscopic cholecystectomy (LC) performed by resident surgeons (RS) and attending surgeons (AS). METHODS In this retrospective review of prospectively collected data 1,747 LC were performed in a community hospital between 1999 and 2009. Seven hundred seventy operations were performed by RS. Parameters analysed included the duration of operation and length of hospital stay, intraoperative complications, 30-day morbidity and mortality. RESULTS Duration of operation was 88 (25-245) min for RS vs. 75 (30-190) min by AS (p = 0.001). Elective operations were shorter when performed by AS (70 (30-190) [AS] vs. 85 (25-240) [RS] min, p = 0.001). Length of hospital stay was shorter in patients treated by RS (4 (1-49) days [RS] vs. 5 (1-83) days [AS], p = 0.1). Intraoperative complications showed no differences between the groups (1.0% [RS] vs. 1.3% [AS], p = 0.6), whereas 30-day morbidity was lower in patients treated by RS (3.8% [RS] vs. 6.2% [AS], p = 0.02). Overall mortality was 0.6% and independent of surgical expertise (0.5% [RS] vs. 0.8% [AS], p = 0.5). CONCLUSIONS Provided adequate training, supervision and patient selection, surgical residents are able to perform LC with results comparable to those of experienced surgeons.
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Affiliation(s)
- René Fahrner
- Department of Surgery, Spital Limmattal, 8952, Schlieren, Switzerland.
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