Hospital Outcomes in Inpatient Laparoscopic Cholecystectomy in Medicare Patients

Fry, Donald E.; Pine, Michael; Nedza, Susan M.; Locke, David; Reband, Agnes M.; Pine, Gregory

doi:10.1097/sla.0000000000001653

Cited by 18 publications

(14 citation statements)

References 22 publications

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“…This corresponds to 2 fewer (0-2 fewer) deaths per 1000 patients based on a baseline risk of 0.6% from observational data. 357 It may not reduce symptomatic PEs following laparoscopic cholecystectomy (RR, 0.48; 95% CI, 0.26-0.88; very low in the evidence of effects), but we are very uncertain of this finding. Given the very low baseline risk of VTE events in this specific patient population, 350 this would be expected to result in 0 fewer (0 fewer to 0 more) symptomatic PEs per 1000 patients.…”

Section: Recommendation 18mentioning

confidence: 96%

American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients

et al. 2019

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Background:Venous thromboembolism (VTE) is a common source of perioperative morbidity and mortality.Objective:These evidence-based guidelines from the American Society of Hematology (ASH) intend to support decision making about preventing VTE in patients undergoing surgery.Methods:ASH formed a multidisciplinary guideline panel balanced to minimize bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic reviews. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment.Results:The panel agreed on 30 recommendations, including for major surgery in general (n = 8), orthopedic surgery (n = 7), major general surgery (n = 3), major neurosurgical procedures (n = 2), urological surgery (n = 4), cardiac surgery and major vascular surgery (n = 2), major trauma (n = 2), and major gynecological surgery (n = 2).Conclusions:For patients undergoing major surgery in general, the panel made conditional recommendations for mechanical prophylaxis over no prophylaxis, for pneumatic compression prophylaxis over graduated compression stockings, and against inferior vena cava filters. In patients undergoing total hip or total knee arthroplasty, conditional recommendations included using either aspirin or anticoagulants, as well as for a direct oral anticoagulant over low-molecular-weight heparin (LMWH). For major general surgery, the panel suggested pharmacological prophylaxis over no prophylaxis, using LMWH or unfractionated heparin. For major neurosurgery, transurethral resection of the prostate, or radical prostatectomy, the panel suggested against pharmacological prophylaxis. For major trauma surgery or major gynecological surgery, the panel suggested pharmacological prophylaxis over no prophylaxis.

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Section: Recommendation 18mentioning

confidence: 96%

American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients

et al. 2019

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“… 20 In a different health care system (Medicare), a similar mortality rate of 3% has been reported in a high-risk population. 21 …”

Section: Discussionmentioning

confidence: 99%

Acute cholecystitis – a cohort study in a real-world clinical setting (REWO study, NCT02796443)

Blythe

Herrmann

Faust

et al. 2018

POR

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BackgroundFor decades, the optimal timing of surgery for acute cholecystitis has been controversial. Recent meta-analyses and population-based studies favor early surgery. One recent large randomized trial has demonstrated that a delayed approach increases morbidity and cost compared to early surgery within 24 hours of hospital admission. Since cases of severe cholecystitis were excluded from this trial, we argue that these results do not reflect real-world clinical situations. From our point of view, these results were in contrast to the clinical experience with our patients; so, we decided to analyze critically all our patients with the null hypothesis that the patients treated with a delayed cholecystectomy after an acute cholecystitis have a similar or even better outcome than those treated with an early operative approach.Patients and methodsWe retrospectively analyzed clinical data from all patients with cholecystectomies in the period between January 2006 and September 2015. A total of 1,723 patients were categorized into four groups: early (n=138): urgent surgery of patients with acute cholecystitis within the first 72 hours of the onset of symptoms; intermediate (n=297): surgery of patients with acute cholecystitis within an average of 10 days after the onset of symptoms; delayed (n=427): initial non-surgical treatment of acute cholecystitis with surgery performed within 6–12 weeks of the onset of symptoms; and elective (n=868): cholecystectomy within a symptom-free interval of choice in patients with symptomatic cholecystolithiasis without signs of acute cholecystitis.ResultsIn a real-world scenario, early/intermediate cholecystectomy in acute cholecystitis was associated with a significant increase in morbidity and mortality (Clavien–Dindo score) compared to a delayed approach with surgery performed 6–12 weeks after the onset of symptoms. The adjusted linear rank statistics showed a decrease in the complication score with values of 2.29 in the early group, 0.48 in the intermediate group, –0.26 in the delayed group and –2.12 in the elective group. The results translate into a continuous decrease of the complication score from early over intermediate and delayed to the elective group.ConclusionThese results demonstrate that delayed cholecystectomy can be performed safely. In cases with severe cholecystitis, early and/or intermediate approaches still have a relatively high risk of morbidity and mortality.

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“…Each year, more than 750000 cholecystectomies are performed in the United States[2,3] and around 48000 in the United Kingdom[4,5]. In the United States in 2004, the direct and indirect costs associated with this pathology amounted to $6.2 billion[1].…”

Section: Introductionmentioning

confidence: 99%

“…Gallstone disease is one of the commonest digestive pathologies[ 1 ], and, as a result, cholecystectomy is one of the most frequently performed surgical procedures. Each year, more than 750000 cholecystectomies are performed in the United States[ 2 , 3 ] and around 48000 in the United Kingdom[ 4 , 5 ]. In the United States in 2004, the direct and indirect costs associated with this pathology amounted to $6.2 billion[ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Ninety-day readmissions after inpatient cholecystectomy: A 5-year analysis

Manuel-Vázquez¹,

Latorre-Fragua²,

Ramiro-Pérez³

et al. 2017

WJG

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AIMTo determine the incidence of readmission after cholecystectomy using 90 d as a time limit.METHODSWe retrospectively reviewed all patients undergoing cholecystectomy at the General Surgery and Digestive System Service of the University Hospital of Guadalajara, Spain. We included all patients undergoing cholecystectomy for biliary pathology who were readmitted to hospital within 90 d. We considered readmission to any hospital service as cholecystectomy-related complications. We excluded ambulatory cholecystectomy, cholecystectomy combined with other procedures, oncologic disease active at the time of cholecystectomy, finding of malignancy in the resection specimen, and scheduled re-admissions for other unrelated pathologies.RESULTSWe analyzed 1423 patients. There were 71 readmissions in the 90 d after discharge, with a readmission rate of 4.99%. Sixty-four point seven nine percent occurred after elective surgery (cholelithiasis or vesicular polyps) and 35.21% after emergency surgery (acute cholecystitis or acute pancreatitis). Surgical non-biliary causes were the most frequent reasons for readmission, representing 46.48%; among them, intra-abdominal abscesses were the most common. In second place were non-surgical reasons, at 29.58%, and finally, surgical biliary reasons, at 23.94%. Regarding time for readmission, almost 50% of patients were readmitted in the first week and most second readmissions occurred during the second month. Redefining the readmissions rate to 90 d resulted in an increase in re-hospitalization, from 3.51% at 30 d to 4.99% at 90 d.CONCLUSIONThe use of 30-d cutoff point may underestimate the incidence of complications. The current tendency is to use 90 d as a limit to measure complications associated with any surgical procedure.

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Hospital Outcomes in Inpatient Laparoscopic Cholecystectomy in Medicare Patients

Abstract: Comparative analysis of overall risk-adjusted inpatient and 90-day postdischarge adverse outcomes identifies considerable opportunity for improved care in this high-risk population of patients.

Cited by 18 publications

References 22 publications

American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients

American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients

Acute cholecystitis – a cohort study in a real-world clinical setting (REWO study, NCT02796443)

Ninety-day readmissions after inpatient cholecystectomy: A 5-year analysis

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Hospital Outcomes in Inpatient Laparoscopic Cholecystectomy in Medicare Patients

Abstract: Comparative analysis of overall risk-adjusted inpatient and 90-day postdischarge adverse outcomes identifies considerable opportunity for improved care in this high-risk population of patients.

Cited by 18 publications

References 22 publications

American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients

American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients

Acute cholecystitis &ndash; a cohort study in a real-world clinical setting (REWO study, NCT02796443)

Ninety-day readmissions after inpatient cholecystectomy: A 5-year analysis

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Acute cholecystitis – a cohort study in a real-world clinical setting (REWO study, NCT02796443)