Background

Acute calculous cholecystitis (ACC) is frequently seen in cirrhotics, with some being poor candidates for initial cholecystectomy. Instead, these patients may undergo percutaneous cholecystostomy tube (PCT) placement. We studied the healthcare utilization and predictors of cholecystectomy and PCT in patients with ACC.

Methods

The National Database was queried to study all cirrhotics and non-cirrhotics with ACC between 2010–2014 who underwent initial PCT (with or without follow-up cholecystectomy) or cholecystectomy. Cirrhotic patients were divided into compensated and decompensated cirrhosis. Independent predictors and outcomes of initial PCT and failure to undergo subsequent cholecystectomy were studied.

Results

Out of 919 189 patients with ACC, 13 283 (1.4%) had cirrhosis. Among cirrhotics, cholecystectomy was performed in 12 790 (96.3%) and PCT in the remaining 493 (3.7%). PCT was more frequent in cirrhotics (3.7%) than in non-cirrhotics (1.4%). Multivariate analyses showed increased early readmissions [odds ratio (OR) = 2.12, 95% confidence interval (CI): 1.43–3.13, P < 0.001], length of stay (effect ratio = 1.39, 95% CI: 1.20–1.61, P < 0.001), calendar-year hospital cost (effect ratio = 1.34, 95% CI: 1.28–1.39, P < 0.001) and calendar-year mortality (hazard ratio = 1.89, 95% CI: 1.07–3.29, P = 0.030) in cirrhotics undergoing initial PCT compared to cholecystectomy. Decompensated cirrhosis (OR = 2.25, 95% CI: 1.67–3.03, P < 0.001) had the highest odds of getting initial PCT. Cirrhosis, regardless of compensated (OR = 0.56, 95% CI: 0.34–0.90, P = 0.020) or decompensated (OR = 0.28, 95% CI: 0.14–0.59, P < 0.001), reduced the chances of getting a subsequent cholecystectomy.

Conclusions

Cirrhotic patients undergo fewer cholecystectomy incurring initial PCT instead. Moreover, the rates of follow-up cholecystectomy are lower in cirrhotics. Increased healthcare utilization is seen with initial PCT amongst cirrhotic patients. This situation reflects suboptimal management of ACC in cirrhotics and a call for action.

中文翻译：

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行动呼吁：随着肝硬化患者在初始胆囊切除术中越来越多地使用经皮胆囊切除术管，医疗保健利用率得到提高

背景

急性结石性胆囊炎(ACC) 常见于肝硬化患者，其中一些不适合初始胆囊切除术。相反，这些患者可能会接受经皮胆囊造口术 (PCT) 放置。我们研究了 ACC 患者胆囊切除术和 PCT 的医疗保健利用率和预测因素。

方法

查询国家数据库以研究 2010 年至 2014 年期间接受初始 PCT（有或没有后续胆囊切除术）或胆囊切除术的所有肝硬化和非肝硬化 ACC。肝硬化患者分为代偿期和失代偿期肝硬化。研究了初始 PCT 和后续胆囊切除术失败的独立预测因素和结果。

结果

在 919 189 名 ACC 患者中，13 283 名（1.4%）患有肝硬化。在肝硬化患者中，12 790 例（96.3%）进行了胆囊切除术，其余 493 例（3.7%）进行了 PCT。肝硬化患者（3.7%）比非肝硬化患者（1.4%）更常见 PCT。多变量分析显示早期再入院率增加 [优势比 (OR) = 2.12, 95% 置信区间 (CI): 1.43–3.13, P  < 0.001], 住院时间 (效果比 = 1.39, 95% CI: 1.20–1.61, P  < 0.001)、日历年住院费用（效果比 = 1.34, 95% CI: 1.28–1.39, P  < 0.001）和日历年死亡率（风险比 = 1.89, 95% CI: 1.07–3.29, P  = 0.030）与胆囊切除术相比，在接受初始 PCT 的肝硬化患者中。失代偿期肝硬化（OR = 2.25, 95% CI: 1.67–3.03, P < 0.001) 获得初始 PCT 的几率最高。肝硬化，无论是否代偿（OR = 0.56, 95% CI: 0.34–0.90, P  = 0.020）或失代偿（OR = 0.28, 95% CI: 0.14–0.59, P  < 0.001），都降低了随后进行胆囊切除术的机会.

结论

肝硬化患者接受较少的胆囊切除术会导致初始 PCT。此外，肝硬化患者的胆囊切除术后随访率较低。在肝硬化患者中使用初始 PCT 可以提高医疗保健利用率。这种情况反映了肝硬化患者对 ACC 的管理欠佳，呼吁采取行动。