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Evolution in the management of acute cholecystitis in the elderly: population-based cohort study

机译:老年人急性胆囊炎急性胆囊炎管理的演变:基于人口的队列队列研究

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Background Acute cholecystitis is a life-threatening emergency in elderly patients. This population-based cohort study aimed to evaluate the commonly used management strategies for elderly patients with acute cholecystitis as well as resulting mortality and re-admission rates. Methods Data from all consecutive elderly patients (≥?80?years) admitted with acute cholecystitis in England from 1997 to 2012 were captured from the Hospital Episode Statistics database. Influence of management strategies upon mortality was analyzed with adjustment for patient demographics and treatment year. Results 47,500 elderly patients were admitted as an emergency with acute cholecystitis. On the index emergency admission the majority of patients ( n ?=?42,620, 89.7%) received conservative treatment, 3539 (7.5%) had cholecystectomy, and 1341 (2.8%) underwent cholecystostomy. In the short term, 30-day mortality was increased in the emergency cholecystectomy group (11.6%) compared to those managed conservatively (9.9%) ( p ?
机译:背景急性胆囊炎是老年患者危及生命的紧急情况。目的是评估常用的管理策略老年急性这一人群队列研究胆囊炎以及导致的死亡率和再住院率。方法从所有连续老年患者数据(≥?80?年)急性承认在英格兰胆囊炎1997年至2012年从医院插曲统计数据库捕获。与调整病人的人口统计和治疗一年后分析,死亡的管理策略的影响。结果47500例老年患者入院与急性胆囊炎的紧急情况。在指数急诊入院的大多数患者(n =?42620,89.7%)接受了保守治疗,3539(7.5%)有胆囊切除术,和1341(2.8%)患者接受胆囊造瘘术。在短期内,30天的死亡率相比,这些管理保守(9.9%)的紧急胆囊切除术组(11.6%)中被升高(p <??0.001)。这是通过胆囊切除术的具有减小的1年死亡率[20.8与对那些管理保守27.1%(P <??0.001)〕的长期益处所抵消。经皮胆囊管理增加了30天和1年死亡率(13.4和35.0%)。进行胆囊切除术的年度比例从27%,2006年腹腔镜提高到59%在2012年内胆囊切除术组,腹腔镜方法是降低30天死亡率(OR 0.16,95%CI 0.10-0.25)的独立预测因子。继保守的管理,有16,088接诊的进一步胆囊炎。只有11%的患者最初管理保守或胆囊收到后续胆囊切除术。结论急性胆囊炎与老年患者显著的死亡率。在选定的老年患者胆囊切除术急救的潜在好处包括减少再住院和1年死亡率率。紧急腹腔镜胆囊切除术的方法是,在30天的死亡率为84%,相对风险降低相比,开放手术有关。

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