目标发布了2018年东京指南(TG18),以促进决策过程(DMP)。包括急性胆囊炎(AC)的诊断和手术。然而,只有少数指南考虑老年人。这项研究基于TG18评估了DMP,重点是老年AC患者。方法这是一个单臂,单中心回顾性研究。主要结果指标是“不可诊断的”AC率,次要结局指标是“不适合手术”决策的一致性程度。患者二百九名AC患者。结果根据TG18标准,209例AC患者中有60例(28.7%)入院时“不可诊断”。≤59、60-79和≥80岁患者的“不可诊断”AC的数量和比率为4(10.0%),20(24.4%),和36(41.4%),分别(P<0.001)。单因素分析后的多因素logistic回归分析显示,年龄>73岁是不可诊断AC的最重要危险因素(P=0.006,比值比[OR]:3.06,95%置信区间[CI]:1.38-6.81)。女性(P=0.033,OR:2.09,95%CI:1.06-4.09)和重度AC(P=0.049,OR:2.97,95%CI:1.01-8.76)也是不可诊断AC的重要危险因素。根据Charlson合并症指数和美国麻醉医师协会的身体状况,不适合手术的病例数为90(43.1%)和75(35.9%),分别。这两个指标之间的κ值显示最小一致性为0.33(95%CI:0.20-0.47)。结论基于TG18的DMP可能存在误判风险,尤其是老年AC患者(UMIN000047715)。
Objective The 2018 Tokyo
Guidelines (TG18) were published to facilitate the decision-making processes (DMP), including the diagnosis and
operation of acute cholecystitis (AC). However, only a few
guidelines consider older adults. This study evaluated the DMP based on the TG18, focusing on older patients with AC. Methods This was a single-armed, single-center retrospective study. The primary outcome measure was the \"undiagnosable\" AC rate, and the secondary outcome measure was the degree of concordance of \"unfit for surgery\" decisions. Patients Two hundred and nine patients with AC. Results Sixty (28.7%) of 209 patients with AC were \"undiagnosable\" on admission based on the TG18 criteria. The numbers and rate of \"undiagnosable\" AC in patients ≤59, 60-79, and ≥80 years old were 4 (10.0%), 20 (24.4%), and 36 (41.4%), respectively (p<0.001). The multiple logistic regression analysis following the univariate analysis revealed that age >73 years old was the most significant risk factor for undiagnosable AC [p=0.006, odds ratio (OR): 3.06, 95% confidence interval (CI): 1.38-6.81]. Female sex (p=0.033, OR: 2.09, 95% CI: 1.06-4.09) and severe AC (p=0.049, OR: 2.97, 95% CI: 1.01-8.76) were also significant risk factors for undiagnosable AC. The number of cases unfit for surgery based on the Charlson Comorbidity Index and American Society of Anesthesiologists physical status was 90 (43.1%) and 75 (35.9%), respectively. The κ value between these 2 indicators revealed a minimal concordance of 0.33 (95% CI: 0.20-0.47). Conclusion The DMP based on the TG18 potentially harbors a misjudgment risk, especially in older patients with AC (UMIN000047715).