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. 2016:2016:7675953.
doi: 10.1155/2016/7675953. Epub 2016 Apr 28.

Factor Analysis Influencing Postoperative Hospital Stay and Medical Costs for Patients with Definite, Suspected, or Unmatched Diagnosis of Acute Cholecystitis according to the Tokyo Guidelines 2013

Aoi Hayasaki  1 , Koji Takahashi  2 , Takehiro Fujii  1 , Koji Kumamoto  2 , Koji Fujii  2 , Eiichi Matsumoto  2 , Shigeki Miyahara  2 , Tsukasa Kusuta  2 , Yoshinori Azumi  3 , Shuji Isaji  3
Affiliations

Factor Analysis Influencing Postoperative Hospital Stay and Medical Costs for Patients with Definite, Suspected, or Unmatched Diagnosis of Acute Cholecystitis according to the Tokyo Guidelines 2013

Aoi Hayasaki et al. Gastroenterol Res Pract. 2016.

Abstract

Purpose. To identify significant independent preoperative factors influencing postoperative hospital stay (PHS) and medical costs (MC) in 171 patients who underwent cholecystectomy for benign gallbladder diseases and had definite, suspected, or unmatched acute cholecystitis (AC) diagnosis according to the Tokyo Guidelines 2013 (TG13). Methods. The 171 patients were classified according to the combination of diagnostic criteria including local signs of inflammation (A), systemic signs of inflammation (B), and imaging findings (C): A+ B+ C (definite diagnosis, n = 84), A+ B (suspected diagnosis, n = 25), (A or B) + C (n = 10), A (n = 41), and B (n = 11). Results. The A+ B + C and (A or B) + C groups had equivalent PHS and MC, suggesting that imaging findings were essential for AC diagnosis. PHS and MC were significantly increased in the order of severity grades based on TG13. Performance status (PS), white blood cell count, and severity grade were identified as preoperative factors influencing PHS by multivariate analysis, and significant independent preoperative factors influencing MC were age, PS, preoperative biliary drainage, hospital stay before surgery, albumin, and severity grade. Conclusion. PS and severity grade significantly influenced prolonged PHS and increased MC.

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Figures

Figure 1
Figure 1
Flow diagram of the 259 patients who underwent cholecystectomy for benign gallbladder diseases according to the diagnostic criteria based on TG13. A, B, and C represent each item in the TG13 diagnostic criteria. AC: acute cholecystitis and TG13: Tokyo Guidelines 2013.
Figure 2
Figure 2
Comparison of PHS and MC in the FFS and DPC systems according to the five groups (n = 171). (a) The differences in the average PHS for each group. (b) The differences in the average MC in the FFS system for each group. (c) The differences in the average MC in the DPC system for each group. PHS: postoperative hospital stay, MC: medical costs, FFS: fee for service, and DPC: diagnosis procedure combination. ∗∗ P < 0.01 and ∗ P < 0.05.
Figure 3
Figure 3
Comparison of PHS and MC according to severity grade (n = 171). (a) The differences in the average PHS for each grade. (b) The differences in the average MC in the FFS system for each grade. (c) The differences in the average MC in the DPC system for each grade. PHS: postoperative hospital stay, MC: medical costs, FFS: fee for service, and DPC: diagnosis procedure combination. ∗∗ P < 0.01 and ∗ P < 0.05.
Figure 4
Figure 4
(a) Relationship between MC in the FFS system and MC in the DPC system (n = 171). (b) Relationship between PHS and MC in the FFS system (n = 171). PHS: postoperative hospital stay, MC: medical costs, FFS: fee for service, and DPC: diagnosis procedure combination.
See this image and copyright information in PMC

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