1. Single center retrospective analysis of early vs. delayed treatment in acute calculous cholecystitis: Application of a clinical pathway and an economic analysis
- Author
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Luca Ansaloni, Michele Pisano, Renata Colombi, Francesco Margarito, Andrea Allegri, Federico Coccolini, Roberto Manfredi, Giulia Montori, Cecilia Merli, Marco Ceresoli, Eugenia Belotti, Dario Piazzalunga, Pisano, M, Ceresoli, M, Allegri, A, Belotti, E, Coccolini, F, Colombi, R, Manfredi, R, Margarito, F, Merli, C, Montori, G, Piazzalunga, D, and Ansaloni, L
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Cost-Benefit Analysis ,Cholecystitis, Acute ,MEDLINE ,Acute ,Single Center ,Acute cholecystiti ,Laparoscopic ,Clinical pathway ,Early laparoscopic cholecystectomy ,Cholecystitis ,Medicine ,Humans ,Cholecystectomy ,Registries ,Timing ,Hospital Costs ,Intensive care medicine ,Retrospective Studies ,Economic analysi ,business.industry ,General surgery ,Economic analysis ,Retrospective cohort study ,Evidence-based medicine ,Acute cholecystitis ,Evidence based medicine ,Cholecystectomy, Laparoscopic ,Critical Pathways ,Female ,Italy ,Length of Stay ,Middle Aged ,medicine.disease ,Anesthesiology and Pain Medicine ,Emergency Medicine ,Surgery ,business ,Complication - Abstract
BACKGROUND: Treatment option and timing for surgery in case of acute calculous cholecystitis (ACC) is still a matter of discussion. Tokyo Guidelines (TG13) offers some rules but they don’t reflect entirely the information of Evidence Based Medicine (EBM). This study aimed to draw some consideration from our practice in the application of the guidelines and put forward the clinical, economic and organizational effect of it. METHODS: The study is a single center retrospective study based on administrative database formed by gathering information from clinical registry. Data were collected between January 1st, 2008 and April 30th, 2013. A cutoff point was established on May 15th, 2010 when we moved from a single surgeon method to a shared EBM method to treat ACC. The economic aspect was developed considering health service reimburse and hospital costs. RESULTS: Five hundred and two patients were selected, 203 patients before the organizational change (Group 0) and 299 after (Group 1). In Group 0, 24.63% of the patients were treated with early laparoscopic cholecystectomy (ELC) and 39.4% received surgery delayed in second admission (DLC). After the change, 57.5% of the patients were treated with ELC while 13% were treated with DLC. Median length of stay (LOS) was significantly lower after the change (9.5 vs. 7.3, p
- Published
- 2015