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Call for action:Increased healthcare utilization with growing use of percutaneous cholecystectomy tube over initial cholecystectomy in cirrhotics

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Hepatobiliary & Pancreatic Diseases International 2022年第1期21卷 56-62页

作者： Srikanth Vedachalam Sajid Jalil somashaker g krishna Kyle Porter Na Li Sean g Kelly Lanla Conteh Khalid Mumtaz Department of Internal Medicine The Ohio State University Wexner Medical CenterColumbusOH 43210USA Division of gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical CenterColumbusOH 43210USA Center for Biostatistics Department of Biomedical InformaticsThe Ohio State University Wexner Medical CenterColumbusOH 43210USA

Background:Acute calculous cholecystitis(ACC)is frequently seen in cirrhotics,with some being poor candidates for initial ***,these patients may undergo percutaneous cholecystostomy tube(PCT)*** studied the healthcare utilization and predictors of cholecystectomy and PCT in patients with ***:The National Database was queried to study all cirrhotics and non-cirrhotics with ACC between 2010-2014 who underwent initial PCT(with or without follow-up cholecystectomy)or *** patients were divided into compensated and decompensated *** predictors and outcomes of initial PCT and failure to undergo subsequent cholecystectomy were ***:Out of 919189 patients with ACC,13283(1.4%)had *** cirrhotics,cholecystec-tomy was performed in 12790(96.3%)and PCT in the remaining 493(3.7%).PCT was more frequent in cirrhotics(3.7%)than in non-cirrhotics(1.4%).Multivariate analyses showed increased early readmis-sions[odds ratio(OR)=2.12,95%confidence interval(CI):1.43-3.13,Pgth of stay(effect ratio=1.39,95%CI:1.20-1.61,Pgoing initial PCT compared to *** cirrhosis(OR=2.25,95%CI:1.67-3.03,Pghest odds of getting initial ***,regardless of compensated(OR=0.56,95%CI:0.34-0.90,P=0.020)or decompensated(OR=0.28,95%CI:0.14-0.59,Pgetting a subsequent ***:Cirrhotic patients undergo fewer cholecystectomy incurring initial PCT ***,the rates of follow-up cholecystectomy are lower in *** healthcare utilization is seen with initial PCT amongst cirrhotic *** situation reflects suboptimal management of ACC in cirrhotics and a call for action.

关键词： National Healthcare Cholecystectomy Percutaneous cholecystostomy Cirrhosis Decompensated cirrhosis

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Trends and outcomes of transarterial chemoembolization in hepatocellular carcinoma:a national survey

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Hepatobiliary & Pancreatic Diseases International 2017年第6期16卷 624-630页

作者： Khalid Mumtaz Nishi Patel Rohan M Modi Vihang Patel Alice Hinton James Hanje Sylvester M Black somashaker krishna Division of gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical Center Columbus OHUSA Department of Internal Medicine The Ohio State University Wexner Medical Center Columbus OHUSA Department of Surgery The Ohio State University Wexner Medical Center Columbus OHUSA Division of Biostatistics College of Public Health The Ohio State University Columbus OH USA

BACKgROUND:Transarterial chemoembolization(TACE) is a palliative procedure frequently used in patients with advanced hepatocellular carcinoma(HCC). We examined the national inpatient trends of TACE and related outcomes in the United States over the last ***:We utilized the National Inpatient Sample(2002 to 2012) and performed trend analyses of TACE for HCC in all adult patients(age >18 years). Multivariate analyses for the outcomes of in-hospital "procedure-related complications"(PRCs) and "post-procedure complications"(PPCs) were performed. We also compared early(2002 to 2006) and late(2007 to 2012) eras by multivariate analyses to identify predictors of complications, healthcare resource utilization and ***:Overall, 19058 patients underwent TACE for HCC where PRCs and PPCs were seen in 24.2% and 17.6% of patients, respectively. The overall trends in the use of TACE(Pg. There was less mortality [adjusted Odds ratio(a OR):0.58; 95% CI:0.41, 0.82], reduced length of hospital stay(-1.87 days; 95% CI:-2.77,-0.97) and increased hospital charges($19232; 95% CI:11013, 27451) in the late era. Additionally, there was increased mortality(a OR:4.07; 95% CI:2.96, 5.59), PRCs(a OR:3.21; 95% CI:2.56, 4.02), and PPCs(a OR:2.70; 95% CI:2.11, 3.46) among patients with ***:There is an increasing trend of TACE utilization in HCC. However, the outcomes are worse in patients with coagulopathy. Although PRCs have increased, mortality has decreased in recent years. These findings should be considered during TACE evaluation in patients with HCC.

关键词： transarterial chemoembolization hepatocellular carcinoma procedural complications mortality

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