Abstract:
Importance:There are currently 2 widely accepted treatment strategies for patients presenting to the hospital with choledocholithiasis. However, the rate of use for each strategy in the United States has not been evaluated, and their trends over time have not been described. Furthermore, an optimal management strategy for choledocholithiasis has yet to be defined. Objective:To evaluate secular trends in the management of choledocholithiasis in the United States and to compare hospital length of stay between patients with choledocholithiasis treated with endoscopic retrograde cholangiopancreatography with laparoscopic cholecystectomy (ERCP+LC) vs laparoscopic common bile duct exploration with laparoscopic cholecystectomy (LCBDE+LC). Design, Setting, and Participants:In this cohort study, we studied patients with a primary diagnosis of choledocholithiasis that were included in the National Inpatient Sample between 1998 and 2013 from a representative sample of acute care hospitals in the United States. Patients with cholangitis or pancreatitis were excluded. Main Outcomes and Measures:Unadjusted and risk-adjusted median hospital length of stay. Results:Of the 37 207 patients included in our analysis, 36 048 (96.9%) were treated with ERCP+LC and 1159 (3.1%) were treated with LCBDE+LC. The mean (SD) age of patients treated with ERCP+LC was 50.7 (21.1) years and was 51.9 (20.9) years for those treated with LCBDE+LC; 25 788 (69.3%) were female. Analysis of the National Inpatient Sample data indicates that there are an average of 26 158 patients with choledocholithiasis admitted in the United States each year. The overall use of CBDE for patients with choledocholithiasis decreased from 39.8% of admissions in 1998 to 8.5% in 2013 (P < .001). A decrease was also seen for open CBDE (30.6% vs 5.5%; P < .001) and laparoscopic CBDE (9.2% vs 3.0%; P < .001) independently. Rates of management with LCBDE+LC decreased from 5.3% to 1.5% (P < .001), while rates of ERCP+LC increased from 52.8% to 85.7% (P < .001). The unadjusted median hospital length of stay was shorter for patients treated with LCBDE+LC than for those treated with ERCP+LC (3.0 vs 4.0 days; P < .001). After risk-adjustment, the median length of stay remained 0.5 days shorter for patients treated with LCBDE+LC than with ERCP+LC (3.5 vs 4.0 days; P < .001). Conclusions and Relevance:This study highlights the marked decline in the use of both open and laparoscopic CBDE in the United States as well as the benefit to the length of stay LCBDE+LC has over ERCP+LC. Despite a persistent need for CBDE and the potential benefits of LCBDE+LC over ERCP+LC for managing choledocholithiasis, if current trends continue, CBDE may be at risk of disappearing from the surgical armamentarium.
journal_name
JAMA Surgjournal_title
JAMA surgeryauthors
Wandling MW,Hungness ES,Pavey ES,Stulberg JJ,Schwab B,Yang AD,Shapiro MB,Bilimoria KY,Ko CY,Nathens ABdoi
10.1001/jamasurg.2016.2059subject
Has Abstractpub_date
2016-12-01 00:00:00pages
1125-1130issue
12eissn
2168-6254issn
2168-6262pii
2544833journal_volume
151pub_type
杂志文章相关文献
JAMA Surgery文献大全abstract:Importance:Opioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking. Objective:To assemble a multidisciplinary team of health care experts an...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.5045
更新日期:2021-01-01 00:00:00
abstract:Importance:Older adults are disproportionately affected by trauma and accounted for 47% of trauma fatalities in 2016. In many populations and disease processes, described risk factors for poor clinical outcomes include sarcopenia and brain atrophy, but these remain to be fully characterized in older trauma patients. Sa...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2019.0988
更新日期:2019-08-01 00:00:00
abstract:IMPORTANCE:The appropriately coached implementation of surgical safety checklists (SSCs) reduces the incidence of perioperative complications and 30-day mortality of patients undergoing surgery. The association of the introduction of SSCs with 90-day mortality remains unclear. OBJECTIVE:To assess the association betwe...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2015.5490
更新日期:2016-07-01 00:00:00
abstract:IMPORTANCE:Among patients presenting with critical lower extremity ischemia, it has been previously documented that white individuals are more likely to undergo revascularization than nonwhite individuals, with the disparity largely attributed to differences in resources and access to care. OBJECTIVE:To investigate th...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.1436
更新日期:2013-07-01 00:00:00
abstract:Importance:Acute cholangitis (AC), particularly severe AC, has historically required urgent endoscopic decompression, although the timing of decompression is controversial. We previously identified 2 admission risk factors for adverse outcomes in AC: total bilirubin level greater than 10 mg/dL and white blood cell coun...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2016.2329
更新日期:2016-11-01 00:00:00
abstract:IMPORTANCE:The rate of complications among injury admissions has been estimated to be more than 3 times that observed for general admissions, and complications have been targeted as an important quality-of-care metric. Despite the negative effect of complications on resource use and patient mortality and morbidity, the...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2015.5484
更新日期:2016-07-01 00:00:00
abstract:Importance:Surgical site infections (SSIs) are common after laparotomy wounds and are associated with a significant economic burden. The use of negative pressure wound therapy (NPWT) has recently been broadened to closed surgical incisions. Objective:To evaluate the association of prophylactic NPWT with SSI rates in c...
journal_title:JAMA surgery
pub_type: 杂志文章,meta分析
doi:10.1001/jamasurg.2018.3467
更新日期:2018-11-01 00:00:00
abstract:Importance:Cigarette smoking is a risk factor for many perioperative complications, including surgical site infection (SSI). The duration of abstinence from smoking required to reduce this risk is unknown. Objectives:To evaluate if abstinence from smoking on the day of surgery is associated with a decreased frequency ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.5704
更新日期:2017-05-01 00:00:00
abstract:IMPORTANCE:The field of transplantation has made tremendous progress since the first successful kidney transplant in 1954. OBJECTIVE:To determine the survival benefit of solid-organ transplant as recorded during a 25-year study period in the United Network for Organ Sharing (UNOS) database and the Social Security Admi...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.2038
更新日期:2015-03-01 00:00:00
abstract:UNLABELLED:IMPORTANCE It is not known whether hospital and surgeon volumes have an association with readmission among patients undergoing pancreatoduodenectomy. OBJECTIVE:To evaluate patient-, surgeon-, and hospital-level factors associated with readmission. DESIGN, SETTING, AND PARTICIPANTS:Retrospective cohort stud...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.2509
更新日期:2013-12-01 00:00:00
abstract:Importance:Women are disproportionately underrecognized as award winners within medical societies. The presence of this disparity has not been investigated in training programs. Objective:To determine the presence of a gender disparity in award winners in general surgery residency programs. Design, Setting, and Parti...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.3518
更新日期:2020-09-02 00:00:00
abstract:Importance:Assessment of physical frailty in older trauma patients admitted to the intensive care unit is often not feasible using traditional frailty assessment instruments. The use of opportunistic computed tomography (CT) scans to assess sarcopenia and osteopenia as indicators of underlying frailty may provide compl...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.4604
更新日期:2017-02-15 00:00:00
abstract:OBJECTIVES:To describe the current state of the science for operating room (OR) briefings and debriefings, including an overview of key definitions, a review of the evidence of effectiveness, and a summary of our experiences as part of a comprehensive unit-based safety program. OVERVIEW:Use of preoperative briefings h...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.172
更新日期:2014-08-01 00:00:00
abstract:Importance:The burden of injury and costs of wrist fractures are substantial. Surgical treatment became popular without strong supporting evidence. Objective:To assess whether current surgical treatment for displaced distal radius fractures provided better patient-reported wrist pain and function than nonsurgical trea...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.5672
更新日期:2021-01-13 00:00:00
abstract:IMPORTANCE:Morphometric assessment has emerged as a strong predictor of postoperative morbidity and mortality. However, a gap exists in translating this knowledge to bedside decision making. We introduced a novel measure of patient-centered surgical risk assessment: morphometric age. OBJECTIVE:To investigate the relat...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.4823
更新日期:2014-04-01 00:00:00
abstract:Importance:Motor vehicle crashes (MVCs) are a leading public health concern. Emergency medical service (EMS) response time is a modifiable, system-level factor with the potential to influence trauma patient survival. The relationship between EMS response time and MVC mortality is unknown. Objectives:To measure the ass...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2018.5097
更新日期:2019-04-01 00:00:00
abstract:Importance:Autologous fat transfer (AFT or fat grafting) has become an invaluable tool for the correction of disfiguring deformities after breast cancer surgery. However, clinical and animal studies have shown conflicting results regarding its oncologic safety. Objective:To determine whether exposure to AFT vs convent...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2018.3744
更新日期:2019-01-01 00:00:00
abstract:Importance:All events that transpire during laparoscopic cholecystectomy (LC) cannot be adequately reproduced in the operative note. Video recording is already known to add important information regarding this operation. Objective:It is hypothesized that additional audio recordings can provide an even better procedura...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.0741
更新日期:2020-07-01 00:00:00
abstract:IMPORTANCE:Hemorrhage is the leading cause of death in military trauma and second leading cause of death in civilian trauma. Although many well-established animal models of hemorrhage exist in the trauma and anticoagulant literature, few focus on directly quantitating blood loss. OBJECTIVE:To establish and validate a ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.1685
更新日期:2015-04-01 00:00:00
abstract:IMPORTANCE:The introduction of hepatoprotective strategies and multidisciplinary management has significantly improved the outcome of neonates with short bowel syndrome (SBS) who require parenteral nutrition (PN). OBJECTIVE:To determine the probability of weaning from PN based on intestinal length in neonates with SBS...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.4332
更新日期:2014-07-01 00:00:00
abstract:Importance:Minimally invasive laparoscopic surgery (MILS) for endometrial cancer reduces surgical morbidity compared with a total abdominal hysterectomy. However, only a minority of women with early-stage endometrial cancer undergo MILS. Objective:To evaluate the association between the Danish nationwide introduction ...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2018.5840
更新日期:2019-06-01 00:00:00
abstract:IMPORTANCE:In recent years, the CD40/CD40L system has been implicated in the pathophysiology of severe chronic inflammatory diseases. Recently, obesity has been described as a low chronic inflammatory disease, so this system could also be involved in the inflammatory process. OBJECTIVE:To study soluble CD40 ligand (sC...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurgery.2013.419
更新日期:2013-02-01 00:00:00
abstract::Fibroepithelial lesions (FELs) are a common histologic finding on core needle biopsy (CNB) of the breast. Fibroepithelial lesions include fibroadenoma and phyllodes tumor, which can be difficult to distinguish with an initial CNB. An institutional experience was reviewed from February 12, 2001, to January 4, 2007, to ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.73
更新日期:2014-10-01 00:00:00
abstract:Importance:Medically treated symptomatic severe aortic stenosis has poor outcomes, and in the past 6 decades, it has successfully been treated with surgical aortic valve replacement (SAVR). However, one-third of patients with indications for SAVR are not offered surgery because of the high risk of complications. Transc...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2019.4449
更新日期:2019-11-27 00:00:00
abstract:Importance:There is limited literature reporting circumstances surrounding end-of-life care in vascular surgery patients. Objective:To identify factors driving end-of-life decisions in vascular surgery patients. Design, Setting, and Participants:In this cohort study, medical records were reviewed for all vascular sur...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.3970
更新日期:2017-02-01 00:00:00
abstract:Importance:The receipt of surgery in freestanding ambulatory surgery centers (ASCs) is often less costly compared with surgery in hospital-based outpatient departments. Although increasing numbers of surgical procedures are now being performed in freestanding ASCs, questions remain regarding the existence of disparitie...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.3318
更新日期:2020-09-09 00:00:00
abstract:Importance:Surgery represents the mainstay treatment of colorectal liver metastases. Indications for the laparoscopic approach in this setting have been widened and there is a need to confirm the benefits of minimally invasive liver surgery (MILS) in patients with complex disease states. Objective:To compare outcomes ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2018.2107
更新日期:2018-11-01 00:00:00
abstract:IMPORTANCE:Surgical site infection remains a major challenge in surgery. Delayed primary closure of dirty wounds is widely practiced in war surgery; we present a meta-analysis of evidence to help guide application of the technique in wider context. OBJECTIVE:To determine using meta-analysis whether delayed primary ski...
journal_title:JAMA surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1001/jamasurg.2013.2336
更新日期:2013-08-01 00:00:00
abstract:Importance:Although many older adults prefer to avoid burdensome interventions with limited ability to preserve their functional status, aggressive treatments, including surgery, are common near the end of life. Shared decision making is critical to achieve value-concordant treatment decisions and minimize unwanted car...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.5674
更新日期:2017-06-01 00:00:00
abstract:IMPORTANCE:To our knowledge, an observational study on the remission of type 2 diabetes mellitus (T2DM) after different types of bariatric surgery based on data from general practice has not been carried out. OBJECTIVE:To assess the effect of different types of bariatric surgery in patients with T2DM on diabetes remis...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2015.2398
更新日期:2015-12-01 00:00:00