Laparoscopic Common Bile Duct Exploration for Choledocholithiasis: Analysis of Practice Patterns of Intermountain HealthCare

被引：22

作者：

Gilsdorf, Daniel ^{[1
]}

Henrichsen, Jake ^{[2
]}

Liljestrand, Katie ^{[2
]}

Staheli, Allison ^{[2
]}

Olsen, Griffin ^{[2
]}

Narayanan, Prem ^{[2
]}

Ott, Mark ^{[2
]}

Morris, David S. ^{[2
]}

Price, Raymond ^{[2
]}

机构：

[1] Univ Utah, Dept Surg, Salt Lake City, UT USA

[2] Intermt Med Ctr, Dept Surg, 5169 S Cottonwood St,Bldg 2,Suite 400, Murray, KY 84107 USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS | 2018年 / 226卷 / 06期

关键词：

PROSPECTIVE RANDOMIZED-TRIAL; SINGLE-STAGE MANAGEMENT; UNITED-STATES; CONCOMITANT GALLSTONES; COMPARING; 2-STAGE; STONES; SURGERY; CHOLECYSTECTOMY; GUIDELINES; ENDOSCOPY;

D O I：

10.1016/j.jamcollsurg.2018.02.008

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

BACKGROUND: The ideal management of common bile duct (CBD) stones remains controversial, whether with single-stage management using laparoscopic CBD exploration (LCBDE) during laparoscopic cholecystectomy, or with 2-stage management using preoperative or postoperative ERCP. We wished to elucidate the practice patterns within our health system, which includes both large urban referral centers and small rural critical access hospitals. STUDY DESIGN: We conducted a retrospective data analysis from our 22-hospital, not-for-profit, integrated healthcare system. All patients with a diagnosis of choledocholithiasis who underwent laparoscopic cholecystectomy (LC) and either ERCP or LCBDE for duct clearance between 2008 and 2013 were included. Demographic data, along with disease-specific characteristics and outcomes, were collected and compared. RESULTS: During the study period, 37,301 patients underwent LC. Of these, 1,961 (5.3%) met inclusion criteria. Single-stage management with LCthornLCBDE was performed in 28% of patients, and the remaining 72% underwent 2-stage management with ERCP (73% postoperative ERCP, 27% preoperative). Mean total number of procedures was lowest in the LCthornLCBDE group vs the post-cholecystectomy ERCP group vs the preoperative ERCP group (mean 1.4 vs 2.1 vs 2.3; p < 0.05). Hospital charges were also lower in the LCthornLCBDE group vs post-cholecystectomy ERCP vs preoperative ERCP groups ($9,000 vs $10,800 vs $14,200; p < 0.05). Single-stage vs two-stage management varied greatly between hospitals (from 0% to 93%). CONCLUSIONS: Single-stage management of CBD stones resulted in the fewest procedures and lower hospital charges without an increase in complications. Single-stage management (LCthornLCBDE) of CBD stones is underused and can offer better value in today's cost-constrained environment. (C) 2018 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.

引用

页码：1160 / 1165

页数：6

共 29 条

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American College of Surgeons, 2017, ACS NSQIP OP MAN

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