癌症患者急性胆囊炎结局和护理流程的变异性

Variation in acute cholecystitis outcomes and processes of care in patients with cancer

SURGERY

影响因子:2.7

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

DOI: 10.1016/j.surg.2024.07.078

摘要

接受积极癌症治疗或患有转移性癌症的患者，发生急性胆囊炎的风险增加，且常由普通外科医生进行诊断和管理。关于这些患者的治疗流程和临床结局的资料较少。有效管理癌症患者中的急性胆囊炎需理解其独特的风险特征及治疗选择。2019年7月1日至2024年2月29日，10家医院收集了急诊普通外科手术数据。筛选出表现为急性胆囊炎的患者进行分析。采用倾向评分匹配，将有无活动性恶性肿瘤的患者组成配对队列。主要结局指标为30天内死亡率，次要结局包括并发症、住院时间、再入院和出院方式。调查的流程包括治疗方式、手术时间和手术技术。分析共包括8,673名患者，平均年龄53.2±19岁，女性占61.4%，非白人占17.8%。其中，3.3%的患者有活动性恶性肿瘤。调整风险后，癌症队列的30天死亡率更高（比值比：5.85，95%置信区间：2.38-14.4，P < .001）。癌症患者还表现出更高的感染性并发症发生率（比值比：2.55，95%置信区间：1.54-4.2，P < .001），其中包括败血症（比值比：2.95，95%置信区间：1.61-5.39，P < .001）和肺炎（比值比：6.67，95%置信区间：1.75-25.3，P < .005）。癌症患者更倾向于接受非手术管理（比值比：2.85，95%置信区间：2.11-3.84，P < .001）。癌症患者在表现为急性胆囊炎后，其临床结局明显较差，且治疗过程存在显著变异，增加了非手术管理的比例。这些结果对该特殊人群的管理策略具有重要启示，尤其是在考虑其对同时进行的肿瘤治疗计划的影响时。

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.