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Tytuł pozycji:

Biliary Enteric Reconstruction After Biliary Injury: Delayed Repair Is More Costly Than Early Repair.

Tytuł:
Biliary Enteric Reconstruction After Biliary Injury: Delayed Repair Is More Costly Than Early Repair.
Autorzy:
Sweigert PJ; Department of Surgery, Loyola University Medical Center, Maywood, Illinois.
Eguia E; Department of Surgery, Loyola University Medical Center, Maywood, Illinois.
Nelson MH; Department of Surgery, Loyola University Medical Center, Maywood, Illinois.
Bunn C; Department of Surgery, Loyola University Medical Center, Maywood, Illinois.
Kulshrestha S; Department of Surgery, Loyola University Medical Center, Maywood, Illinois.
Luchette FA; Department of Surgery, Loyola University Medical Center, Maywood, Illinois.
Baker MS; Department of Surgery, Loyola University Medical Center, Maywood, Illinois. Electronic address: .
Źródło:
The Journal of surgical research [J Surg Res] 2021 Jan; Vol. 257, pp. 349-355. Date of Electronic Publication: 2020 Sep 03.
Typ publikacji:
Comparative Study; Journal Article
Język:
English
Imprint Name(s):
Publication: New York, NY : Academic Press
Original Publication: Philadelphia [etc.]
MeSH Terms:
Bile Ducts/*injuries
Bile Ducts/*surgery
Cholecystectomy/*adverse effects
Time-to-Treatment/*economics
Aged ; Cholecystectomy/economics ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Time Factors
Contributed Indexing:
Keywords: Bile duct injury; Cholecystectomy; Hepaticojejunostomy; Outcomes; Reconstruction; Timing
Entry Date(s):
Date Created: 20200906 Date Completed: 20210104 Latest Revision: 20210104
Update Code:
20240105
DOI:
10.1016/j.jss.2020.08.023
PMID:
32892130
Czasopismo naukowe
Background: Bile duct injury (BDI) during cholecystectomy requiring biliary enteric reconstruction (BER) is associated with increased risk of postoperative mortality and substantive increases in costs of care. The impact of the timing of repair on overall costs of care is poorly understood.
Materials and Methods: The Healthcare Cost and Utilization Project Florida State databases (2006-2015) were queried to identify patients undergoing BER within 1-y of cholecystectomy performed for benign biliary disease. Patients were then categorized by the time interval between cholecystectomy to BER: early (≤3 d), intermediate (4 d to 6 wk), or delayed (>6 wk). By repair timing strategy, 1-y outcomes were aggregated, including charges, inpatient costs, aggregate length of stay, and inpatient mortality.
Results: Of 563,887 patients undergoing cholecystectomy, 1168 required a BER (0.21%) within 1-y of cholecystectomy. Early BER was performed in 560 patients (47.9%), intermediate BER in 439 patients (37.6%), and delayed BER in 169 (14.5%) patients. On multivariable analysis adjusting for patient, procedure, and facility factors, intermediate BER demonstrated an increased risk of mortality (odds ratio 2.04, 95% confidence interval [CI]: 1.16-3.56) and increased aggregate inpatient cost (+$12,472; 95% CI: $6421-$18,524) relative to early BER. There was no notable difference in adjusted risk of inpatient mortality between the early and delayed BER cohorts (odds ratio 0.90; 95% CI: 0.32-1.25), but delayed BER was associated with increased aggregate inpatient costs (+$45,111; 95% CI: $36,813-$53,409).
Conclusions: When compared with delayed BER, early repair was associated with shorter aggregate inpatient hospitalization without increased postoperative mortality. Intermediate timing of repair is associated with increased costs and risk of mortality.
(Copyright © 2020 Elsevier Inc. All rights reserved.)

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