Surgeon Variability Impacts Costs in Laparoscopic Cholecystectomy: the Volume-Cost Relationship
AbstractBackgroundPhysician variation in adherence to best practices contributes to the high costs of health care. Understanding surgeon-specific cost variation in common surgical procedures may inform strategies to improve the value of surgical care.MethodsLaparoscopic cholecystectomies at a single institution were identified over a 5-year period and linked to an institutional cost database. Multiple linear regression was used to control for patient-, case-, and hospital-specific factors while assessing the impact of surgeon variability on cost.ResultsThe final dataset contained 1686 patients. Higher surgeon volume (reported in tertiles) was associated with decreased costs ($5354 vs. $6301 vs. $7156,p
Publication date: Available online 9 October 2020Source: Hepatobiliary &Pancreatic Diseases InternationalAuthor(s): Suhyun Lim, Chang Hwan Kim, Kwang Yeol Paik, Wook Kim
Conclusion: MRCP is valuable for identification of bile duct variation and CBD stones. Preoperative MRCP can be considered, particularly in patients with elevated γ-GT, for proper preoperative management and avoidance of complications. PMID: 33029481 [PubMed]
This report shows that ICG-fluorescence can be helpful in identifying the extrahepatic biliary anatomy during the dissection of Calot's triangle in both elective and emergency cases. PMID: 33031562 [PubMed - as supplied by publisher]
AbstractBackgroundThe dose and dosing time of indocyanine green (ICG) vary among fluorescence cholangiography (FC) studies. The purpose of this prospective, randomized, exploratory clinical trial was to optimize the dose and dosing time of ICG.MethodsPubMed was searched to determine the optimal dose. To optimize the dosing time of ICG, a clinical trial was designed with two parts. The first part included patients with T tubes for more than 1 month. After the patient was injected with ICG, bile was collected at 10 time points to explore the change and trends of bile fluorescence intensity (FI). In addition, the result...
CONCLUSIONS: The present study showed evidence that palonosetron is superior to the drugs compared regarding a protracted antiemetic effect and less requirement of rescue drugs, mainly related to its ability to completely inhibit the uncomfortable symptom of nausea. PMID: 33010934 [PubMed - as supplied by publisher]
ConclusionsLCBDE + LC and IO-ERCP + LC have similar efficacy and safety in terms of technical success, morbidity, major morbidity, and conversion rate. However, LCBDE + LC is associated with a higher biliary leak rate, lower postoperative pancreatitis rate, and higher rate of retained stones.
This study utilizes the Veterans Affairs Surgical Quality Improvement Program database to examine the status and outcome of cholecystectomy.MethodsA retrospective review of veterans who underwent cholecystectomy between 2008 and 2015 was performed. Data analysis included patient demographics, operations, and postoperative outcomes. Cochran-Armitage trend analysis was used to assess significant changes in outcome over the study period.p ≤ 0.05 was considered significant.ResultsA total of 40,722 patients (average age of 61 years) were included in the study (males 85.6%). LC was performed in the majorit...
This study aims to examine nationwide trends in the surgical management of acute cholecystitis, as well as their impact on clinical outcomes during pregnancy.MethodsThe National Inpatient Sample was queried for all pregnant women diagnosed with acute cholecystitis between January 2003 and September 2015. After applying appropriate weights, multivariate regression analysis adjusted for patient- and hospital-level characteristics and quantified the impact of discharge year (2003–2007 versus 2008–2015) on cholecystectomy rates and timing of surgery. Multivariate regression analysis was also used to examine t...
Publication date: Available online 2 October 2020Source: International Journal of Surgery Case ReportsAuthor(s): Adel Elkbuli, Evander Meneses, Kyle Kinslow, Mark McKenney, Dessy Boneva
Conclusions: The increased age causes the unfavorable changes in early postoperative immunoinflammatory indices after the uncomplicated laparoscopic cholecystectomy. Thus, the term “elderly” can be rephrased by the term “vulnerable to various surgical stresses.” The thresholds for “elderly” defined herein seem impractical. Namely, the increased vulnerability caused by the aging seems modified by the individual surgical procedures.