PURPOSE: There are several preoperative treatment options, such as the staged bile duct intervention (BDI), for the successful completion of a cholecystectomy, regardless of the use of an open cholecystectomy (OC) or a laparoscopic cholecystectomy (LC). However, few studies have investigated how the characteristics of the patient or the hospital affect the preoperative resource use. This study determined the factors, including the hospital characteristics, associated with the preoperative resource utilization or with the treatment process. METHODS: Cholecystectomy patients (n = 12 627) who were treated for benign gallbladder diseases were examined. The study variables were: the patient demographics; the comorbid conditions; the presence of inflammation; the BDI, including endoscopic retrograde cholangiopancreatography, percutaneous gallbladder or common bile duct drainage, endoscopic sphincterotomy, clearance of choledocholithiasis; the preoperative length of stay (LOS) or the total charges; and the hospital region, ownership, and function. A multivariate analysis was used to measure the variables associated with the use of preoperative resources. RESULTS: A total of 11,690 (85.1%) patients underwent LC. The inflammation was diagnosed in 72.5% of OC and 41.5% of LC patients. Bile duct intervention was performed in more of the OC patients. The preoperative BDI had a significantly greater impact on the LOS. The hospital demographics predicted the preoperative resource use and the implementation of the BDI. CONCLUSIONS: The preoperative BDI involved the use of more preoperative resources. A wide variation of the use of BDI was observed in the hospital demographics. Further study is needed to establish a preoperative treatment strategy for cholecystectomy patients.
PURPOSE: There are several preoperative treatment options, such as the staged bile duct intervention (BDI), for the successful completion of a cholecystectomy, regardless of the use of an open cholecystectomy (OC) or a laparoscopic cholecystectomy (LC). However, few studies have investigated how the characteristics of the patient or the hospital affect the preoperative resource use. This study determined the factors, including the hospital characteristics, associated with the preoperative resource utilization or with the treatment process. METHODS: Cholecystectomy patients (n = 12 627) who were treated for benign gallbladder diseases were examined. The study variables were: the patient demographics; the comorbid conditions; the presence of inflammation; the BDI, including endoscopic retrograde cholangiopancreatography, percutaneous gallbladder or common bile duct drainage, endoscopic sphincterotomy, clearance of choledocholithiasis; the preoperative length of stay (LOS) or the total charges; and the hospital region, ownership, and function. A multivariate analysis was used to measure the variables associated with the use of preoperative resources. RESULTS: A total of 11,690 (85.1%) patients underwent LC. The inflammation was diagnosed in 72.5% of OC and 41.5% of LC patients. Bile duct intervention was performed in more of the OC patients. The preoperative BDI had a significantly greater impact on the LOS. The hospital demographics predicted the preoperative resource use and the implementation of the BDI. CONCLUSIONS: The preoperative BDI involved the use of more preoperative resources. A wide variation of the use of BDI was observed in the hospital demographics. Further study is needed to establish a preoperative treatment strategy for cholecystectomy patients.
Authors: A M Carbonell; A E Lincourt; K W Kercher; B D Matthews; W S Cobb; R F Sing; B T Heniford Journal: Surg Endosc Date: 2005-05-03 Impact factor: 4.584