癌症患者急性胆囊炎结局和护理过程的变化
Variation in acute cholecystitis outcomes and processes of care in patients with cancer
影响因子:2.70000
分区:医学2区 / 外科2区
发表日期:2025 Mar
作者:
Patrick L Johnson, Jonathan E Williams, Sara L Schaefer, Laura Gerhardinger, Hugh J Lindsey, Carl Pesta, Amanda Yang, Mary A Hunter, Jennifer J Griggs, Mark R Hemmila
摘要
接受活跃癌症治疗或转移性癌症的患者患急性胆囊炎的风险增加，并且经常向普通外科医生出现进行评估和管理。关于这些患者使用的治疗过程以及实现的临床结果的数据很少。癌症患者急性胆囊炎的最佳治疗需要了解其独特的风险特征和治疗选择。从2019年7月1日到2024年2月29日，在10家医院收集了紧急通用手术数据。选择了出现急性胆囊炎的患者进行分析。倾向评分匹配用于通过存在或不存在主动恶性肿瘤来创建匹配的患者队列。主要结果是30天死亡率。次要结果包括并发症，住院时间，再入院和出院处置。研究的过程包括治疗方式，手术时间和手术技术。分析包括8,673名患者。平均年龄为53.2±19岁，女性为61.4％，非白人为17.8％。总共3.3％的患者患有主动恶性肿瘤。癌症队列中的风险调整后30天死亡率更高（优势比：5.85，95％置信区间：2.38-14.4，p <.001）。 Patients with cancer also had higher rates of infectious complications (odds ratio: 2.55, 95% confidence interval: 1.54-4.2, P < .001), including sepsis (odds ratio: 2.95, 95% confidence interval: 1.61-5.39, P < .001) and pneumonia (odds ratio: 6.67, 95% confidence interval: 1.75-25.3, P < .005).癌症患者更有可能接受非手术治疗（几率：2.85，95％置信区间：2.11-3.84，p <.001）。患有急性胆囊炎的癌症患者在控制其他因素后会经历更严重的临床结果。此外，治疗过程有所不同，非手术管理率提高。这些结果对该人群的管理具有影响，特别是在对并发肿瘤治疗计划的影响方面。
Abstract
Patients undergoing active cancer therapy or with metastatic cancer are at increased risk for acute cholecystitis and often present to general surgeons for evaluation and management. There is a paucity of data regarding the treatment processes used in these patients and the clinical outcomes achieved. Optimal management of acute cholecystitis in patients with cancer requires understanding their unique risk profile and options for treatment.Emergency general surgery data were collected at 10 hospitals from July 1, 2019, to February 29, 2024. Patients presenting with acute cholecystitis were selected for analysis. Propensity score matching was used to create matched cohorts of patients by the presence or absence of an active malignancy. The primary outcome was 30-day mortality. Secondary outcomes included complications, length of stay, readmission, and discharge disposition. Processes investigated include treatment modality, time to operation, and surgical technique.The analysis included 8,673 patients. Mean age was 53.2 ± 19 years, 61.4% were female, and 17.8% were non-White. In total, 3.3% of patients had an active malignancy. Risk-adjusted 30-day mortality was higher in the cancer cohort (odds ratio: 5.85, 95% confidence interval: 2.38-14.4, P < .001). Patients with cancer also had higher rates of infectious complications (odds ratio: 2.55, 95% confidence interval: 1.54-4.2, P < .001), including sepsis (odds ratio: 2.95, 95% confidence interval: 1.61-5.39, P < .001) and pneumonia (odds ratio: 6.67, 95% confidence interval: 1.75-25.3, P < .005). Patients with cancer were more likely to receive nonoperative management (odds ratio: 2.85, 95% confidence interval: 2.11-3.84, P < .001).Patients with cancer presenting with acute cholecystitis experience worse clinical outcomes after controlling for other factors. Furthermore, there is variation in the treatment process with increased rates of nonoperative management. These results have implications for the management of this population, particularly in relation to the impact on concurrent oncologic treatment plans.