Donald E Fry1, Michael Pine2, Gregory Pine3. 1. Michael Pine and Associates, Chicago, IL; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; University of New Mexico School of Medicine, Albuquerque, NM. Electronic address: dfry@consultmpa.com. 2. Michael Pine and Associates, Chicago, IL; Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL. 3. Michael Pine and Associates, Chicago, IL.
Abstract
BACKGROUND: Little information is available about postdischarge adverse events after laparoscopic cholecystectomy. METHODS: Inpatient and 90-day postdischarge adverse events were identified for Medicare patients discharged in 2009-2010 after undergoing elective laparoscopic cholecystectomy on day 0, 1, or 2 of hospitalization at facilities that performed 20 or more laparoscopic cholecystectomies during the study period. A predictive length of stay (LOS) linear regression model was derived and used to identify patients with prolonged LOS (prLOS) whose risk-adjusted LOS exceeded a 3σ upper limit on a moving average control chart. Rates of inpatient and 90-day fatal and nonfatal adverse events and interrelationships among different outcomes and alternative outcome measures were explored. RESULTS: Of 89,639 study cases, 0.7% died during their index hospitalization, and 1.3% died within 90 days of discharge. Of live discharges, 8.0% had prLOS, and 42.1% had coded complication. In the 90 days after discharge, 9,416 (10.6%) were readmitted. Patients who were prLOS outliers were more likely to die or be readmitted than nonoutliers (P < .0001; χ(2)). CONCLUSION: More than 18% of Medicare patients undergoing presumably low-risk elective inpatient laparoscopic cholecystectomy died, had a severe inpatient complication, or were readmitted within 90 days of discharge.
BACKGROUND: Little information is available about postdischarge adverse events after laparoscopic cholecystectomy. METHODS: Inpatient and 90-day postdischarge adverse events were identified for Medicare patients discharged in 2009-2010 after undergoing elective laparoscopic cholecystectomy on day 0, 1, or 2 of hospitalization at facilities that performed 20 or more laparoscopic cholecystectomies during the study period. A predictive length of stay (LOS) linear regression model was derived and used to identify patients with prolonged LOS (prLOS) whose risk-adjusted LOS exceeded a 3σ upper limit on a moving average control chart. Rates of inpatient and 90-day fatal and nonfatal adverse events and interrelationships among different outcomes and alternative outcome measures were explored. RESULTS: Of 89,639 study cases, 0.7% died during their index hospitalization, and 1.3% died within 90 days of discharge. Of live discharges, 8.0% had prLOS, and 42.1% had coded complication. In the 90 days after discharge, 9,416 (10.6%) were readmitted. Patients who were prLOS outliers were more likely to die or be readmitted than nonoutliers (P < .0001; χ(2)). CONCLUSION: More than 18% of Medicare patients undergoing presumably low-risk elective inpatient laparoscopic cholecystectomy died, had a severe inpatient complication, or were readmitted within 90 days of discharge.
Authors: Kristoffer W Brudvik; Yoshihiro Mise; Claudius Conrad; Giuseppe Zimmitti; Thomas A Aloia; Jean-Nicolas Vauthey Journal: J Am Coll Surg Date: 2015-02-28 Impact factor: 6.113
Authors: Alba Manuel-Vázquez; Raquel Latorre-Fragua; Carmen Ramiro-Pérez; Aylhin López-Marcano; Farah Al-Shwely; Roberto De la Plaza-Llamas; José Manuel Ramia Journal: World J Gastroenterol Date: 2017-04-28 Impact factor: 5.742