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| 1 | Operative complications and economic outcomes of cholecystectomy for acute cholecystitis显示文摘BACKGROUND Recent management of acute cholecystitis favors same admission(SA)or emergent cholecystectomy based on overall shorter hospital stay and therefore cost savings.We 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 practice.We hypothesized that the existence of complications,particularly among patients with a higher degree of disease severity,during SA cholecystectomy could negate the cost savings.AIM To compare complication rates and hospital costs between SA vs delayed cholecystectomy among patients admitted emergently for acute cholecystitis.METHODS 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 period.Patients were identified using the acute care surgery registry and billing database.Data was retrieved via EMR,operative logs,and Revenue Cycle Operations.The severity of acute cholecystitis was graded according to the Tokyo Guidelines.TG18 categorizes acute cholecystitis by Grades 1,2,and 3 representing mild,moderate,and severe,respectively.Comparisons were analyzed withχ2,Fisher’s exact test,ANOVA,ttests,and logistic regression;significance was set at P<0.05.RESULTS Four hundred eighty-six(87.7%)underwent a SA while 68 patients(12.3%)received Delayed cholecystectomy.Complication 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 Delayed.Patients 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=0.019).The relative risk of developing a complication was 4.2x[95%confidence interval(CI):1.4-12.9]in the SA vs Delayed groups.Among eight patients(95%CI:5.0-12.3)with acute cholecystitis undergoing SA cholecystectomy,one patient will suffer a complication.CONCLUSION Patients with Tokyo Grade 2 acute cholecystitis had more complications and increased hospital charges when undergoing SA cholecystectomy.This data supports a selective approach to SA cholecystectomy for acute cholecystitis. | Christopher P Rice Krishnamurthy B Vaishnavi Celia Chao Daniel Jupiter August B Schaeffer Whitney R Jenson Lance W Griffin William J Mileski | 2019 | World Journal of Gastroenterology2019，25，48： | 8 |
| 2 | Bubbles and capital flow volatility: Causes and risk management 显示文摘 | Caballero R J Krishnamurthy A | 2006 | Journal of Monetary Economics2006，53，1： | 1 |
| 3 | Regional Study for Mapping the Natural Resources Prospect & Problem Zones Using Remote Sensing and GIS显示文摘 | J Krishnamurthy | 2005 | Geocarto International2005，20，3： | 1 |
| 4 | Transient oxidative stress in SH-SYSY human neuroblastoma cells results in caspase dependent and independent cell death and tau proteolysis显示文摘 | Krishnamurthy PK Mays J L Bij ur GN | 2000 | Neuroscience Research2000，61，5： | 1 |
| 5 | Atheroembol- ic renal disease: effect on morbidity and survival after revascularization for athemsclerotic renal artery stenosis 显示文摘 | Krishnamurthi V Novick A C Myles J L | 1999 | J Urol1999，161，4： | 1 |
| 6 | Stable carbon isotope biogeochemistu of a shallow sand aquifer contam- inated with fuel hydrocarbons显示文摘 | Fang J S Barcelona M J Krishnamurthy R V | 2000 | Applied Geochemistry2000，15，2： | 1 |
| 7 | Particle filters for state estimation of jump Markov linear systems显示文摘 | Arnaud Doucet Neil J Gordon Vikram Krishnamurthy | 2001 | IEEE Trans on Signal Processing2001，49，3： | 1 |
| 8 | DART:Dynamic Address RouTing for Scalable Ad Hoc and Mesh Networks显示文摘 | Eriksson J Faloutsos M Krishnamurthy S | | 0，，01： | 1 |
| 9 | Particle filters for state estimation of jump Markov linear systems显示文摘 | DOUCET A GORDON N J KRISHNAMURTHY V | 2001 | IEEE Transactions on Signal Processing2001，49，3： | 1 |
| 10 | Particle filters for state estimation of jump Markov linear systems 显示文摘 | Doucet A Gordon N J Krishnamurthy V | 2001 | IEEE Transactions on Signal Processing2001，49，： | 1 |
| 11 | wideband radio propagation modeling for indoor geolocation applications 显示文摘 | Pahlavan K Krishnamurthy P Beneat J | 1998 | IEEE Communications Magazine1998，，： | 1 |
| 12 | Isotopic and molecular analyses of hydrocarbons and monocarboxylic acids from the Murchison meteorite显示文摘 | KRISHNAMURTHY R V EPSTEIN S CRONIN J R | 1992 | Geochimica et Cosmochimica Acta1992，56，： | 1 |
| 13 | Pyranonaphthoquinone lactones: a new class of AKT selective kinase inhibitors alkylate a regulatory loop cysteine显示文摘 | Salaski E J Krishnamurthy G Ding WD | 2009 | J Med Chem2009，52，8： | 1 |
| 14 | Simplified point defect model for growth of anodic passive films on iron显示文摘 | Balaji Krishnamurthy Ralph E White Harry J Ploehn | 2002 | Electrochemical Acta2002，，6： | 1 |
| 15 | Microscopic and spectroscopy evaluation of inactivation of Staphylococcus aureus by pulsed UV light and infrared heating显示文摘 | Krishnamurthy K Tewari J C Irudayaraj J | 2010 | Food and Bioprocess Technology2010，3，1： | 1 |
| 16 | Seasonal persistence and propagation of intraseasonal patterns over the Indian monsoon region显示文摘 | Krishnamurthy V Shukla J | 2008 | Climate Dynamics2008，30，4： | 1 |
| 17 | Is CO2 an Indoor Pollutant? Direct Effects of Low-to-Moderate CO2 Concentrations on Human Decision-Making Performance显示文摘 | Satish Usha Mendell Mark J Shekhar Krishnamurthy Hotchi Toshifumi Sullivan Douglas Streufert Siegfried Fisk William J | 2012 | Environmental Health Perspectives2012，，12： | 1 |
| 18 | Correlation of increased PARP14and CCL26expression in biopsies from children with eosinophilic esophagitis显示文摘 | KRISHNAMURTHY P SHERRILL J D PARASHETTE K | 2014 | J Allergy Clin Immunol2014，133，： | 1 |
| 19 | Histogram-based morphological edge detector显示文摘 | Krishnamurthy S Lyengar S S Holyer R J | 1994 | IEEE Transactions on Geoscience and Remote Sensing1994，32，4： | 1 |
| 20 | Identification of a novel penicillin-binding protein from Helicobacter pylori 显示文摘 | Krishnamurthy P Parlow MH Schneider J | 1999 | J Bacteriol1999，181，16： | 1 |
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