A235 DETERMINANTS AND OUTCOMES OF EARLY CHOLECYSTECTOMY FOR GALLSTONE PANCREATITIS IN BRITISH COLUMBIA.
Notice bibliographique
Résumé
Abstract Background Gallstone pancreatitis is the most common cause of pancreatitis, with early cholecystectomy reducing recurrence and improving outcomes compared to delayed surgery or ERCP alone. However, the use of early cholecystectomy in British Columbia (BC) and its long-term effects are not well understood. Aims This study will evaluate the prevalence and outcomes of early cholecystectomy in BC, potentially contributing to improved management guidelines. Methods A retrospective multicenter analysis of patients with gallstone pancreatitis admitted from 2018 to 2023 to four hospitals within BC. Patients with prior cholecystectomy or pancreatic cancer were excluded from the analysis. Patients with moderate or severe pancreatitis as determined by the revised Atlanta criteria were excluded. Patients who received a cholecystectomy in under 4 weeks were labelled as early, whereas over 4 weeks or not at all were labelled as late. Baseline characteristics, details of cholecystectomy and outcomes were recorded. Results A total of 193 patients with a mean age of 58.5 years (SD 18.4) and 60.1% female were included. 84 patients underwent early cholecystectomy (43.5%) including during the index admission (36.3%). Patients who received early cholecystectomy were younger (52.6 years vs 62.9 years, P<0.001) with fewer comorbidities (Charlson comorbidity index 1.5 vs 2.8, P<0.001). Patient gender, body mass index or hospital type were not associated with early cholecystectomy. Early cholecystectomy patients were more likely admitted by a surgeon (OR 11.7, 95% CI 4.6 to 29.6, P<0.001), offered cholecystectomy at index admission (OR 59.8, 95% CI 24.5 to 146.0, P<0.001), and receive cholecystectomy at index admission (OR 497, 95% CI 64.1 to 3848, P<0.001). There was no difference in the symptom onset to admission time interval or length of stay. ERCP was equally likely in both groups (OR 0.62, 95% CI 0.34 to 1.1, P=0.12). Patients who received early cholecystectomy were less likely to have a recurrent biliary event (HR 0.26, 95% CI 0.15 to 0.45, P<0.001). Pancreatitis was the most common (81.1%) recurrent biliary event. Reasons for not undergoing early cholecystectomy included: referral to outpatient cholecystectomy as the most common (29.7%), age and/or comorbidities (25.0%) and patient declining surgery (21.9%). Conclusions Early cholecystectomy reduces recurrent rates of biliary events. Admission under surgery and offering surgery at the index admission were much more likely in the early group. Early surgical involvement may be an important factor in achieving higher rates of index admission cholecystectomy. Funding Agencies None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».