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Operative complications and economic outcomes of cholecystectomy for acute cholecystitis

World Journal of Gastroenterology 2019年第48期25卷 6916-6927页

作者： Christopher P Rice Krishnamurthy B Vaishnavi Celia Chao daniel jupiter August B Schaeffer Whitney R Jenson Lance W Griffin William J Mileski School of Medicine University of Texas Medical BranchGalvestonTX 77555United States Department of Surgery University of Texas Medical BranchGalvestonTX 77555United States Department of Biostatistics University of Texas Medical BranchGalvestonTX 77555United States

BACKGROUND Recent management of acute cholecystitis favors same admission(SA)or emergent cholecystectomy based on overall shorter hospital stay and therefore cost *** adopted the practice of SA cholecystectomy for the treatment of acute cholecystitis at our tertiary care center and wanted to evaluate the economic benefit of this *** hypothesized that the existence of complications,particularly among patients with a higher degree of disease severity,during SA cholecystectomy could negate the cost *** To compare complication rates and hospital costs between SA vs delayed cholecystectomy among patients admitted emergently for acute *** Under an IRB-approved protocol,complications and charges for were obtained for SA,later after conservative management(Delayed),or elective cholecystectomies over an 8.5-year *** were identified using the acute care surgery registry and billing *** was retrieved via EMR,operative logs,and Revenue Cycle *** severity of acute cholecystitis was graded according to the Tokyo ***18 categorizes acute cholecystitis by Grades 1,2,and 3 representing mild,moderate,and severe,*** were analyzed withχ2,Fisher’s exact test,ANOVA,ttests,and logistic regression;significance was set at P<*** Four hundred eighty-six(87.7%)underwent a SA while 68 patients(12.3%)received Delayed *** rates were increased after SA compared to Delayed cholecystectomy(18.5%vs 4.4%,P=0.004).The complication rates of patients undergoing delayed cholecystectomy was similar to the rate for elective cholecystectomy(7.4%,P=0.35).Mortality rates were 0.6%vs 0%for SA vs *** with moderate disease(Tokyo 2)suffered more complications among SA while none who were delayed experienced a complication(16.1%vs 0.0%,P<0.001).Total hospital charges for SA cholecystectomy were increased compared to a Delayed approach($44500±$59000 vs$35300±$16700,P=

关键词： Acute cholecystitis Tokyo guidelines Cholecystectomy Complications Delayed cholecystectomy

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Comparing Methods of Applying the Propensity Score to Control Selection Bias in Studies of Prostate Cancer

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Journal of Health Science 2016年第5期4卷 262-276页

作者： Xiao Fang1 Vahakn Bedig Shahinian Kristin Marie Sheffield Alai Tan daniel Chaim jupiter Yong-Fang Kuo Department of Preventive Medicine and Community Health the University of Texas Medical Branch Galveston 77555 USA University of Michigan Internal Medicine-Nephrology Ann Arbor USA Global Patient Outcomes and Real World Evidence Eli Lilly Indianapolis 46285 USA Sealy Center on Aging the Ohio State University Columbus 43210 USA

To compare the performance of four common methods of applying propensity scores： covariate adjustment, stratification, matching, and inverse probability of treatment weighting, in addressing issues of selection bias. The linked Surveillance, Epidemiology, and End Results Medicare database was used in this study. We compared mortality of patients with localized prostate cancer, in two different scenarios. In Scenario 1, treatment effect on non-prostate cancer mortality were compared between patients with localized prostate cancer receiving active treatment （radical prostatectomy or radiation） and those only being observed. In Scenario 2, prostate cancer specific mortality was compared between localized prostate cancer patients with and without primary androgen deprivation therapy （ADT）. The known confounding factors of comorbidity （Scenario 1） or tumor grade （Scenario 2） were removed to evaluate the ability of each propensity score method to control for the selection bias caused by the presence of the factors. Matching yields slightly better control than the three other methods. None of the propensity score methods can eliminate bias caused by removing a known confounder.

关键词： Selection bias propensity score prostate cancer.

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Awareness and use of cardiovascular risk scores by family physicians in southeastern Ontario

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Open Journal of Preventive Medicine 2013年第8期3卷 487-490页

作者： Murray F. Matangi David W. J. Armstrong Amer M. Johri Ursula Jurt Peter M. Hollett Robert W. Del Grande J. Paul DeYoung Joel M. Niznick daniel D. Broiullard Belleville General Hospital Belleville Canada Cornwall General Hospital Cornwall Canada Division of Cardiology Kingston General Hospital and Queen’s University Kingston Canada Ottawa Cardiovascular Centre Ottawa Canada Perth & Smiths Falls District Hospital Perth Canada The Kingston Heart Clinic Kingston Canada

Background: Our objective was to determine the assessment of cardiovascular risk by family physicians. Methods: A questionnaire was sent by mail or fax regarding both awareness and use of the various CV risk scores in southeastern Ontario. Results: Of 181 family physicians surveyed, 96% were aware of at least one CV risk score and 40% were aware of the jupiter study. Despite this awareness, 72% simply counted risk factors to assess risk, rather than to calculate risk using established scoring methods. Only 23% used the jupiter study criteria. This suggests an under-estimated of overall CV risk by family physician’s practicing in southeastern Ontario. Interpetation: Cardiovascular risk in primary care is being underestimated in southeastern Ontario. Additional knowledge translation strategies are required to enhance the family physician’s awareness and use of established risk scoring methods if we are to reduce the burden of CV disease.

关键词： Risk Assessment Primary Prevention Cardiovascular Disease

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