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Scala A, Trunfio TA, Improta G. Classification and regression model to manage the hospitalization for laparoscopic cholecystectomy. Sci Rep 2023; 13:14700. [PMID: 37679406 PMCID: PMC10485042 DOI: 10.1038/s41598-023-41597-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023] Open
Abstract
Gallstone disease (GD) is one of the most common morbidities in the world. Laparoscopic Cholecystectomy (LC) is currently the gold standard, performed in about 96% of cases. The most affected groups are the elderly, who generally have higher pre- and post-operative morbidity and mortality rates and longer Length of Stay (LOS). For this reason, several indicators have been defined to improve quality and efficiency and contain costs. In this study, data from patients who underwent LC at the "San Giovanni di Dio e Ruggi d'Aragona" University Hospital of Salerno in the years 2010-2020 were processed using a Multiple Linear Regression (MLR) model and Classification algorithms in order to identify the variables that most influence LOS. The results of the 2352 patients analyzed showed that pre-operative LOS and Age were the independent variables that most affected LOS. In particular, MLR model had a R2 value equal to 0.537 and the best classification algorithm, Decision Tree, had an accuracy greater than 83%. In conclusion, both the MLR model and the classification algorithms produced significant results that could provide important support in the management of this healthcare process.
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Affiliation(s)
- Arianna Scala
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Teresa Angela Trunfio
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Giovanni Improta
- Department of Public Health, University of Naples "Federico II", Naples, Italy
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples "Federico II", Naples, Italy
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Fundus first as the standard technique for laparoscopic cholecystectomy. Sci Rep 2019; 9:18736. [PMID: 31822771 PMCID: PMC6904718 DOI: 10.1038/s41598-019-55401-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/27/2019] [Indexed: 01/10/2023] Open
Abstract
In previous studies the fundus first technique (FF) has been a cost-effective way to simplify the laparoscopic cholecystectomy (LC) and facilitate patient rehabilitation. The feasibility and safety profile when introducing FF as the standard technique were aimed in this study. Between 2004–2014, 29 surgeons performed 1425 LC with FF and 320 with a conventional technique. During the first year 56% were with FF and 98% during the last four years. More females, ultrasonic shears, urgent operations, daycare operations and a shorter operation time were found with FF. 63 (3.6%) complications occurred: 10 (0.6%) bleedings, 33 (1.9%) infections and 12 (0.7%) bile leakages. Leakage from cystic duct occurred in 4/112 (3.6%) when closed with ultrasonic shears and in 4/1633 (0.2%) with clips (p 0.008). A common bile duct lesion occurred in 1/1425 (0.07%) with FF and in 3/320 (0.9%) with the conventional approach (p 0.003). In a multivariate regression model, the conventional technique was a risk factor for bile duct injury with an odds ratio of 20.8 (95% CI 1.6–259.2). In conclusion FF was effectively established as the standard procedure and associated with lower rates of bile duct injuries. Clipless closure of the cystic duct increased the rate of leakage.
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Atasoy D, Aghayeva A, Sapcı İ, Bayraktar O, Cengiz TB, Baca B. Effects of prior abdominal surgery on laparoscopic cholecystectomy. Turk J Surg 2018; 34:217-220. [PMID: 30216161 DOI: 10.5152/turkjsurg.2017.3930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/17/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES With increased experience and technological advancement, laparoscopic cholecystectomy is reported to be safe and feasible even in the presence of most of the previously recognized contraindications. The purpose of this study was to explore the effects of prior upper and lower abdominal surgery on laparoscopic cholecystectomy. MATERIAL AND METHODS A retrospective evaluation of all sequential patients who underwent laparoscopic cholecystectomy from January 2014 to June 2016 was conducted. Patients were divided into three groups (Group A: patients without any prior abdominal surgical procedures; Group B: patients with prior upper abdominal surgical procedures; and Group C: patients with prior lower abdominal surgical procedures). RESULTS A total of 329 patients were assessed. Group A consisted of 223, Group B of 18, and Group C of 88 patients. A statistically significantly higher operative time, postoperative pain, and complication rate after laparoscopic cholecystectomy were noted in patients with prior upper abdominal surgery. The groups were comparable regarding patients' demographics and surgery indications. The length of hospital stay was not statistically different between the groups (p=0.065). CONCLUSION According to the results of the current study, prior upper abdominal surgery leads to a significantly longer procedure time, higher postoperative pain, and complication rates after laparoscopic cholecystectomy. However, the length of hospital stay was not affected by the parameters investigated.
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Affiliation(s)
- Deniz Atasoy
- Department of General Surgery, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Afag Aghayeva
- Department of General Surgery, Acıbadem University School of Medicine, İstanbul, Turkey
| | - İpek Sapcı
- Student, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Onur Bayraktar
- Department of General Surgery, Acıbadem University School of Medicine, İstanbul, Turkey
| | | | - Bilgi Baca
- Department of General Surgery, Acıbadem University School of Medicine, İstanbul, Turkey
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Borges MDC, Takeuti TD, Terra JA, Silva AAD, Crema E. Comparative study of respiratory muscle strength in women undergoing conventional and single-port laparoscopic cholecystectomy. Acta Cir Bras 2017; 32:881-890. [PMID: 29160375 DOI: 10.1590/s0102-865020170100000010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/18/2017] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To evaluate respiratory muscle strength (PImax and PEmax) before and 24 and 48 h after conventional and single-port laparoscopic cholecystectomy. METHODS Forty women with symptomatic cholelithiasis (18 to 70 years) participated in the study. The patients were divided into two groups: 21 patients undergoing conventional laparoscopic cholecystectomy and 19 patients undergoing single-port laparoscopic cholecystectomy. Differences were considered to be significant when p<0.05. RESULTS The results showed a greater decline in PImax after 24 h in the group submitted to conventional laparoscopic cholecystectomy, with a significant difference between groups (p=0.0308). CONCLUSION Recovery of the parameters studied was more satisfactory and respiratory muscle strength was less compromised in the group submitted to single-port laparoscopic cholecystectomy.
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Affiliation(s)
- Marisa de Carvalho Borges
- PhD, Physiotherapist, Department of Surgery, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba-MG, Brazil. Intellectual and scientific content of the study, manuscript writing, critical revision
| | - Tharsus Dias Takeuti
- PhD of Health Sciences, Department of Surgery, UFTM, Uberaba-MG, Brazil. Intellectual and scientific content of the study, manuscript writing, critical revision
| | - Júverson Alves Terra
- PhD, Full Professor, Department of Surgery, UFTM, Uberaba-MG, Brazil. Scientific content of the study, technical procedures, critical revision
| | - Alex Augusto da Silva
- PhD, Full Professor, Department of Surgery, UFTM, Uberaba-MG, Brazil. Scientific content of the study, technical procedures, critical revision
| | - Eduardo Crema
- PhD, Full Professor, Department of Surgery, UFTM, Uberaba-MG, Brazil. Scientific content of the study, technical procedures, critical revision
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Terra Júnior JA, Terra GA, Borges MDC, Takeuti TD, Castro LGP, Lima SS, Fernandes LFRM, Silva AAD, Crema E. Comparative study of pain in women submitted to conventional laparoscopic cholecystectomy versus single-port laparoscopic cholecystectomy. Acta Cir Bras 2017; 32:475-481. [DOI: 10.1590/s0102-865020170060000008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/26/2017] [Indexed: 01/07/2023] Open
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Colon Cancer Surgery: A Retrospective Study Based on a Large Administrative Database. Surg Laparosc Endosc Percutan Tech 2016; 26:e126-e131. [DOI: 10.1097/sle.0000000000000350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Open versus laparoscopic cholecystectomies in patients with or without type 2 diabetes mellitus in Spain from 2003 to 2013. Hepatobiliary Pancreat Dis Int 2016. [DOI: 10.1016/s1499-3872(16)60091-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Suuronen S, Kivivuori A, Tuimala J, Paajanen H. Bleeding complications in cholecystectomy: a register study of over 22,000 cholecystectomies in Finland. BMC Surg 2015; 15:97. [PMID: 26268709 PMCID: PMC4535785 DOI: 10.1186/s12893-015-0085-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 08/04/2015] [Indexed: 12/15/2022] Open
Abstract
Background Major bleeding is rare but among the most serious complications of laparoscopic surgery. Still very little is known on bleeding complications and related blood component use in laparoscopic cholecystectomy (LC). The aim of this study is to compare bleeding complications, transfusion rates and related costs between LC and open cholecystectomy (OC). Methods Data concerning LCs and OCs and related blood component use between 2002 and 2007 were collected from existing computerized medical records (Finnish Red Cross Register) of ten Finnish hospital districts. Results Register data included 17175 LCs and 4942 OCs. In the LC group, 1.3 % of the patients received red blood cell (RBC) transfusion compared to 13 % of the patients in the OC group (p < 0.001). Similarly, the proportions of patients with platelet (0.1 % vs. 1.2 %, p < 0.001) and fresh frozen plasma (FFP) products (0.5 % vs. 5.8 %) transfusions were respectively higher in the OC group than in the LC group. The mean transfused dose of RBCs, PTLs and FFP product Octaplas® or the mean cost of the transfused blood components did not differ significantly between the LC and OC groups. Conclusions Laparoscopic cholecystectomy was associated with lower transfusion rates of blood components compared to open surgery. The severity of bleeding complications may not differ substantially between LC and OC.
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Affiliation(s)
- S Suuronen
- Department of Surgery, Mikkeli Central Hospital, 50100, Mikkeli, Finland
| | - A Kivivuori
- Department of Surgery, Mikkeli Central Hospital, 50100, Mikkeli, Finland
| | - J Tuimala
- Finnish Red Cross Blood Service, 00100, Helsinki, Finland
| | - H Paajanen
- Department of Surgery, Kuopio University Hospital, PL 1777, 70600, Kuopio, Finland. .,School of Medicine, University of Eastern Finland, 70600, Kuopio, Finland.
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Assessment and classification of cystic arteries with 64-detector row computed tomography before laparoscopic cholecystectomy. Surg Radiol Anat 2015; 37:1027-34. [PMID: 25940813 DOI: 10.1007/s00276-015-1479-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 04/25/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Major complications of laparoscopic cholecystectomy are bleeding and bile duct injury, and it is necessary to clearly identify structures endoscopically to keep bleeding and injury from occurring. The aim of this study was to depict the anatomical variation between cystic arteries among patients using 64-detector row spiral computed tomography (CT) prior to laparoscopic cholecystectomy. METHODS A total of 78 patients (31 men, 47 women) who underwent cholecystectomy were examined preoperatively using 64-detector row spiral CT between April 2012 and June 2013. The origin and number of cystic arteries and their relationship with the Calot triangle was evaluated by two independent observers. CT images were compared with laparoscopic cholecystectomy results. RESULTS The cystic arteries were delineated by CT in 73 of the 78 patients. The relationship between the cystic arteries and the Calot triangle was identified in 71 of the 78 patients. One cystic artery was found in 53 (73%) of the 73 patients, while two cystic arteries were found in 20 (27%) of the patients. A total of 55 (60%) of the 91 cystic arteries passed through the Calot triangle. The remaining 36 cystic arteries (40%) passed anterior, posterior, or inferior to the cystic duct. The relationship between the cystic arteries and the Calot triangle detected by CT was in agreement with the surgical records for all patients. CONCLUSION The configuration of the cystic arteries and their relationship with the Calot triangle can be identified using 64-detector row CT before laparoscopic cholecystectomy.
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Agresta F, Campanile FC, Vettoretto N, Silecchia G, Bergamini C, Maida P, Lombari P, Narilli P, Marchi D, Carrara A, Esposito MG, Fiume S, Miranda G, Barlera S, Davoli M. Laparoscopic cholecystectomy: consensus conference-based guidelines. Langenbecks Arch Surg 2015; 400:429-53. [PMID: 25850631 DOI: 10.1007/s00423-015-1300-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/24/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) is the gold standard technique for gallbladder diseases in both acute and elective surgery. Nevertheless, reports from national surveys still seem to represent some doubts regarding its diffusion. There is neither a wide consensus on its indications nor on its possible related morbidity. On the other hand, more than 25 years have passed since the introduction of LC, and we have all witnessed the exponential growth of knowledge, skill and technology that has followed it. In 1995, the EAES published its consensus statement on laparoscopic cholecystectomy in which seven main questions were answered, according to the available evidence. During the following 20 years, there have been several additional guidelines on LC, mainly focused on some particular aspect, such as emergency or concomitant biliary tract surgery. METHODS In 2012, several Italian surgical societies decided to revisit the clinical recommendations for the role of laparoscopy in the treatment of gallbladder diseases in adults, to update and supplement the existing guidelines with recommendations that reflect what is known and what constitutes good practice concerning LC.
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Affiliation(s)
- Ferdinando Agresta
- Department of Surgery, Presidio Ospedaliero di Adria (RO), Adria, RO, Italy,
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Buja A, Canavese D, Furlan P, Lago L, Saia M, Baldo V. Are hospital process quality indicators influenced by socio-demographic health determinants. Eur J Public Health 2015; 25:759-65. [PMID: 25667156 DOI: 10.1093/eurpub/cku253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This population-level health service study aimed to address whether hospitals assure the same quality of care to people in equal need, i.e. to see if any associations exist between social determinants and adherence to four hospital process indicators clearly identified as being linked to better health outcomes for patients. PARTICIPANTS This was a retrospective cohort study based on administrative data collected in the Veneto Region (northeast Italy). We included residents of the Veneto Region hospitalized for ST-segment elevation myocardial infarction (STEMI) or acute myocardial infarction (AMI), hip fracture, or cholecystitis, and women giving birth, who were discharged from any hospital operating under the Veneto Regional Health Service between January 2012 and December 2012. METHOD The following quality indicator rates were calculated: patients with STEMI-AMI treated with percutaneous coronary intervention, elderly patients with hip fractures who underwent surgery within 48 h of admission, laparoscopic cholecystectomies and women who underwent cesarean section. A multilevel, multivariable logistic regression analyses were conducted to test the association between age, gender, formal education or citizenship and the quality of hospital care processes. RESULTS All the inpatient hospital care process quality indicators measured were associated with an undesirable number of disparities concerning the social determinants. CONCLUSION Monitoring the evidence-based hospital health care process indicators reveals undesirable disparities. Administrative data sets are of considerable practical value in broad-based quality assessments and as a screening tool, also in the health disparities domain.
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Affiliation(s)
- Alessandra Buja
- 1 Department of Molecular Medicine, Laboratory of Public Health and Population Studies, University of Padova, Padova, Italy
| | - Daniel Canavese
- 2 Universida de Federal do Paraná, Setor Litoral Universidade Federal do Rio Grande do Sul, Curso de Saúde Coletiva, Brazil
| | - Patrizia Furlan
- 1 Department of Molecular Medicine, Laboratory of Public Health and Population Studies, University of Padova, Padova, Italy
| | - Laura Lago
- 3 Masters Course in Sciences of the Public Health and Prevention Professions, University of Padova, Padova, Italy
| | - Mario Saia
- 4 Heath Directorate, Veneto Region, Padova, Italy
| | - Vincenzo Baldo
- 1 Department of Molecular Medicine, Laboratory of Public Health and Population Studies, University of Padova, Padova, Italy
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Pålsson SH, Sandblom G. Influence of gender and socioeconomic background on the decision to perform gallstone surgery: a population-based register study. Scand J Gastroenterol 2015; 50:211-6. [PMID: 25413566 DOI: 10.3109/00365521.2014.978818] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In the absence of unequivocal standardized indications for surgery, socioeconomic background and gender may have a major impact on the decision to perform surgery for cholecystolithiasis. The purpose was to assess how decisions to perform surgery in Sweden are influenced by patient-related factors and how this affects the epidemiology of gallstone disease. MATERIALS AND METHODS This study is based on the Swedish Register for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks), which covers >90% of surgical units, including 98% of all procedures performed. All procedures performed during 2005-2009 were included. Data on socioeconomic background were obtained from Statistics Sweden. The influence of gender and age on decision to perform surgery was tested in multivariate linear regression analysis. RESULTS Up to the age of 40 years, women were 6 times more likely than men to undergo surgery for biliary colic. On the other hand, there was a relative preponderance of men undergoing cholecystectomy for jaundice, cholecystitis, bile duct stone or pancreatitis in the elderly population (p < 0.001). Socioeconomic background did not have any significant impact on the decision to operate. CONCLUSION Presentations of gallstone disease differ between men and women, as does the decision to perform surgery. The higher incidence of surgery for secondary complications in older men could be explained by a higher prevalence of gallstones resulting from a lower incidence of surgery at a younger age. Whether or not wider indications for surgery in young patients reduce the risk for gallstone complications requiring surgery should be explored in future studies.
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Affiliation(s)
- Simon H Pålsson
- Department of Surgery, Sahlgrenska University Hospital , Östra, Gothenburg , Sweden
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Estimation of the time of a linear trend in monitoring survival time. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2014. [DOI: 10.1007/s10742-014-0115-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Disparities in use of laparoscopic hysterectomies: a nationwide analysis. J Minim Invasive Gynecol 2013; 21:223-7. [PMID: 24012920 DOI: 10.1016/j.jmig.2013.08.709] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 07/29/2013] [Accepted: 08/04/2013] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To determine patient and hospital characteristics that were associated with undergoing laparoscopic hysterectomy compared with abdominal hysterectomy. DESIGN Canadian Task Force Classification II-3. METHODS In this retrospective cohort study, we analyzed the 2010 Healthcare Cost and Utilization Project Nationwide Inpatient Sample database. All women who underwent laparoscopic or abdominal hysterectomy for either menorrhagia or leiomyoma were included based on International Classification of Diseases, Ninth Revision coding. A linear model with binomial distribution and logit link function was used to determine patient and hospital characteristics associated with hysterectomy approach. MAIN RESULTS A total of 32 436 patients were included in this study. Of these, 32% patients underwent laparoscopic hysterectomies, and 67% underwent abdominal hysterectomies. With regard to patient characteristics, women younger than 35 years old were more likely to undergo laparoscopic hysterectomy when compared with each of the other age categories (p < .001). White women were more likely to undergo laparoscopic hysterectomy than black women, Hispanic women, or women classified as "other" races (p < .001 for all comparisons). With regard to median income, patients from the lowest national quartile were less likely to undergo laparoscopic hysterectomy when compared with each of the other 3 national quartiles for income (p = .01, p < .001, p = .001, respectively). Payment by private insurance was associated with laparoscopic hysterectomy when compared with payment by Medicare or payment by insurance category "other" (p < .001 for both). With regard to hospital characteristics, hospitals in the Northeast were more likely to have laparoscopic hysterectomies than hospitals in the Midwest or South (p < .001 for both comparisons); urban hospitals were more likely than rural hospitals (p < .001); teaching hospitals were more likely than nonteaching hospitals (p < .001); and government-owned hospitals were less likely than private, nonprofit or private, investor owned (p < .001 for both comparisons). CONCLUSIONS Despite the increased popularity of and training in laparoscopic hysterectomies, there remains an obvious disparity in its delivery with regard to patient and hospital characteristics. Further investigation is needed on the etiology of this disparity and interventions that may alleviate it.
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