Laparoscopic cholecystectomy decreases extra surgical site morbidity compared with open cholecystectomy: A propensity matched analysis.
Identifieur interne : 000312 ( Main/Exploration ); précédent : 000311; suivant : 000313Laparoscopic cholecystectomy decreases extra surgical site morbidity compared with open cholecystectomy: A propensity matched analysis.
Auteurs : Chadli Dziri ; Imen Samaali ; Samia Ben Osman ; A. Fingerhut ; Riadh Bédoui ; Youssef Chaker ; Ibtissem Bouasker ; Ramzi NouiraSource :
- La Tunisie medicale [ 0041-4131 ]
Descripteurs français
- KwdFr :
- MESH :
- méthodes : Cholécystectomie.
- statistiques et données numériques : Durée du séjour.
- Adulte d'âge moyen, Analyse appariée, Complications postopératoires, Durée opératoire, Femelle, Humains, Mâle, Score de propension, Sujet âgé.
English descriptors
- KwdEn :
- MESH :
- methods : Cholecystectomy.
- statistics & numerical data : Length of Stay.
- Aged, Female, Humans, Male, Matched-Pair Analysis, Middle Aged, Operative Time, Postoperative Complications, Propensity Score.
Abstract
BACKGROUND
The ideal way to show treatment effectiveness is through randomized controlled trials the 'gold standard' in evidence-based surgery. Indeed, not all surgical studies can be designed as randomized trials, sometimes for ethical and otherwise, for practical reasons. This article aimed to compare laparoscopic cholecystectomy to open cholecystectomy, according to data from an administrative database, managed by a propensity matched analysis.
METHODS
Were included all patients with cholelithiasis admitted in Department B between June 1st, 2008 and December 31st, 2009. In this study, the propensity score represented the probability that a patient would be treated by a procedure based on variables that were known or suspected to influence group assignment and was developed using multivariable logistic regression used here to match patients who had laparoscopic cholecystectomy to a control patient who had open cholecystectomy. The main outcome measure was morbidity. This was expressed as the number of patients with 1 or more complications occurring during the hospital stay or within 30 days following discharge.
RESULTS
According to intention to treat, 535 patients had a laparoscopic approach (LC group) and 60 patients had a traditional open approach (OC group) regarding associated cardiac disease, previous laparotomy or when choledocholithiasis was suspected, however intra operative cholangiography showed that there was no choledocolithiasis. According to the propensity score, 28 patients in OC were matched with 58 in LC. Comparison between OC and LC before and after propensity matched analysis showed that OC was associated with a higher rate of Extra Surgical Site morbidity (p= 0.010), a longer median duration of intervention, post-operative stay and overall hospital stay (p= 0. 0001).
CONCLUSION
LC should be considered as first-line therapy to treat cholelithiasis surgically even if it becomes necessary to convert to OC because of intra operative findings.
PubMed: 26815513
Affiliations:
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Le document en format XML
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<term>Length of Stay (statistics & numerical data)</term>
<term>Male (MeSH)</term>
<term>Matched-Pair Analysis (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Operative Time (MeSH)</term>
<term>Postoperative Complications (MeSH)</term>
<term>Propensity Score (MeSH)</term>
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<term>Analyse appariée (MeSH)</term>
<term>Cholécystectomie (méthodes)</term>
<term>Complications postopératoires (MeSH)</term>
<term>Durée du séjour (statistiques et données numériques)</term>
<term>Durée opératoire (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>Humains (MeSH)</term>
<term>Mâle (MeSH)</term>
<term>Score de propension (MeSH)</term>
<term>Sujet âgé (MeSH)</term>
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<keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Length of Stay</term>
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<keywords scheme="MESH" qualifier="statistiques et données numériques" xml:lang="fr"><term>Durée du séjour</term>
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<term>Humans</term>
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<term>Middle Aged</term>
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<term>Postoperative Complications</term>
<term>Propensity Score</term>
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<term>Complications postopératoires</term>
<term>Durée opératoire</term>
<term>Femelle</term>
<term>Humains</term>
<term>Mâle</term>
<term>Score de propension</term>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>The ideal way to show treatment effectiveness is through randomized controlled trials the 'gold standard' in evidence-based surgery. Indeed, not all surgical studies can be designed as randomized trials, sometimes for ethical and otherwise, for practical reasons. This article aimed to compare laparoscopic cholecystectomy to open cholecystectomy, according to data from an administrative database, managed by a propensity matched analysis.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>Were included all patients with cholelithiasis admitted in Department B between June 1st, 2008 and December 31st, 2009. In this study, the propensity score represented the probability that a patient would be treated by a procedure based on variables that were known or suspected to influence group assignment and was developed using multivariable logistic regression used here to match patients who had laparoscopic cholecystectomy to a control patient who had open cholecystectomy. The main outcome measure was morbidity. This was expressed as the number of patients with 1 or more complications occurring during the hospital stay or within 30 days following discharge.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>According to intention to treat, 535 patients had a laparoscopic approach (LC group) and 60 patients had a traditional open approach (OC group) regarding associated cardiac disease, previous laparotomy or when choledocholithiasis was suspected, however intra operative cholangiography showed that there was no choledocolithiasis. According to the propensity score, 28 patients in OC were matched with 58 in LC. Comparison between OC and LC before and after propensity matched analysis showed that OC was associated with a higher rate of Extra Surgical Site morbidity (p= 0.010), a longer median duration of intervention, post-operative stay and overall hospital stay (p= 0. 0001).</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSION</b>
</p>
<p>LC should be considered as first-line therapy to treat cholelithiasis surgically even if it becomes necessary to convert to OC because of intra operative findings.</p>
</div>
</front>
</TEI>
<affiliations><list></list>
<tree><noCountry><name sortKey="Bedoui, Riadh" sort="Bedoui, Riadh" uniqKey="Bedoui R" first="Riadh" last="Bédoui">Riadh Bédoui</name>
<name sortKey="Ben Osman, Samia" sort="Ben Osman, Samia" uniqKey="Ben Osman S" first="Samia" last="Ben Osman">Samia Ben Osman</name>
<name sortKey="Bouasker, Ibtissem" sort="Bouasker, Ibtissem" uniqKey="Bouasker I" first="Ibtissem" last="Bouasker">Ibtissem Bouasker</name>
<name sortKey="Chaker, Youssef" sort="Chaker, Youssef" uniqKey="Chaker Y" first="Youssef" last="Chaker">Youssef Chaker</name>
<name sortKey="Dziri, Chadli" sort="Dziri, Chadli" uniqKey="Dziri C" first="Chadli" last="Dziri">Chadli Dziri</name>
<name sortKey="Fingerhut, A" sort="Fingerhut, A" uniqKey="Fingerhut A" first="A" last="Fingerhut">A. Fingerhut</name>
<name sortKey="Nouira, Ramzi" sort="Nouira, Ramzi" uniqKey="Nouira R" first="Ramzi" last="Nouira">Ramzi Nouira</name>
<name sortKey="Samaali, Imen" sort="Samaali, Imen" uniqKey="Samaali I" first="Imen" last="Samaali">Imen Samaali</name>
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