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首页> 外文期刊>Surgical Endoscopy >Risk factors for 30-day readmission and indication for ERCP following laparoscopic cholecystectomy: a retrospective NSQIP cohort study
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Risk factors for 30-day readmission and indication for ERCP following laparoscopic cholecystectomy: a retrospective NSQIP cohort study

机译：腹腔镜胆囊切除术后30天的阅览室危险因素及ERCP的指示：回顾性NSQIP队列研究

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Background Laparoscopic cholecystectomy (LC) is one of the safest, most commonly performed surgical procedures, but postoperative complications including bile leak, retained stone, cholangitis, and gallstone pancreatitis following LC occur in up to 2.6% of cases and may require readmission with possible endoscopic retrograde cholangiopancreatography (ERCP) intervention. There is a paucity of literature on factors predictive of need for ERCP following LC. The goal of this study is to describe the prevalence and risk factors for readmission with indication for ERCP. Methods We queried the ACS/NSQIP 2012-2017 Participant User Files for patients who underwent LC. Patient demographics, comorbidities, operative characteristics, and postoperative outcomes were evaluated. Multivariate logistic regression was used to identify risk factors for readmission with indication for ERCP intervention. Results Of 275,570 patients, 11,010 (4.00%) were readmitted within the 30-day postoperative period. Among these, 930 (8.44%) were admitted with indication for ERCP intervention. On multivariate regression, readmissions were more likely in older patients, inpatients, and patients with baseline comorbidities, acute preoperative morbidity, and those discharged to care facilities. The use of intraoperative cholangiogram was associated with lower odds of readmission. Less than 10% of readmitted patients had an indication for ERCP. Those who were readmitted with an indication for ERCP were more likely to have undergone emergency surgery, experienced longer operative times, and had elevated preoperative LFTs or gallstone pancreatitis prior to surgery. The risk of 30-day mortality was significantly higher among patients who experienced any complications after their surgery (OR 13.03, 95% CI 10.57-16.07, p < 0.001). Conclusions Older patients, patients with greater preoperative morbidity, and those discharged to care facilities were more likely to be readmitted for any reason following laparoscopic cholecystectomy, whereas patients with evidence of complicated gallstone disease were more likely to be readmitted with an indication for ERCP, even when controlling for the use of intraoperative cholangiogram. Initiatives aimed at reducing readmission with indication for ERCP should focus on these patient subgroups.
机译：背景腹腔镜胆囊切除术（LC）是最安全、最常用的外科手术之一，但LC术后并发症包括胆漏、结石残留、胆管炎和胆石性胰腺炎的发生率高达2.6%，可能需要再次入院，可能需要内镜逆行胰胆管造影（ERCP）干预。关于预测LC术后需要ERCP的因素的文献很少。本研究的目的是描述再入院的患病率和风险因素，以及ERCP的适应症。方法我们查询了ACS/NSQIP 2012-2017年LC患者的参与者用户文件。评估患者人口统计学、共病、手术特征和术后结果。多因素logistic回归分析用于确定再次入院的危险因素，并有ERCP干预的指征。结果275570例患者中，11010例（4.00%）在术后30天内再次入院。其中930人（8.44%）因有ERCP介入指征而入院。在多元回归分析中，老年患者、住院患者、基线共病患者、急性术前发病率患者以及出院到护理机构的患者再次入院的可能性更大。术中胆道造影的使用与较低的再入院几率相关。再入院患者中只有不到10%有ERCP指征。有ERCP指征的再入院患者更有可能接受急诊手术，经历更长的手术时间，术前LFT或胆石性胰腺炎升高。在术后出现任何并发症的患者中，30天死亡率的风险显著较高（OR 13.03，95%可信区间10.57-16.07，p<0.001）。结论老年患者、术前发病率较高的患者以及出院到护理机构的患者在腹腔镜胆囊切除术后因任何原因再次入院的可能性更大，而有证据表明患有复杂胆石症的患者在有ERCP指征的情况下再次入院的可能性更大，即使控制了术中胆道造影的使用。旨在减少有ERCP指征的再入院率的举措应侧重于这些患者亚组。

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