背景:关于胆囊切除术的纵向趋势及其结局的人群数据很少。我们评估了新泽西州(NJ)急诊和门诊胆囊切除术的发生率和病死率,以及Medicaid扩展是否改变了趋势。
方法:采用回顾性人群队列设计研究2009年至2018年胆囊切除术的发生率及其病死率。使用线性和逻辑回归,我们探索了2014年1月1日医疗补助扩大之前的发病率趋势和病死率。
结果:总体而言,进行了93,423例紧急胆囊切除术,644人死亡;进行了87,239例动态胆囊切除术,死亡人数少于10人。2009年至2018年紧急胆囊切除术的年发病率从每100,000NJ人口114.8下降至77.5(P<0.0001);动态胆囊切除术从每100,000人口93.5上升至95.6(P=0.053)。急诊胆囊切除术后的发生率比医疗补助扩大前下降更多(P<0.0001)。在扩张后与扩张前进行紧急胆囊切除术的患者中,病死率的比值比为0.85(95%CI,0.72-0.99)。病死率的下降,仅在65岁以上的人群中明显,没有通过增加医疗补助来解释。
结论:扩大医疗补助后,紧急胆囊切除术的发生率显着降低,这并不是由于动态胆囊切除术的发病率增加了很小的原因。由于医疗补助以外的因素,急诊胆囊切除术的病死率随着时间的推移而下降。需要进一步的工作来调和这些发现与先前报道的新泽西州总体胆结石疾病死亡率下降的缺乏。
Population data on longitudinal trends for cholecystectomies and their outcomes are scarce. We evaluated the incidence and
case fatality rate of emergency and ambulatory cholecystectomies in New Jersey (NJ) and whether the Medicaid expansion changed trends.
A retrospective population cohort design was used to study the incidence of cholecystectomies and their
case fatality rate from 2009 to 2018. Using linear and logistic regression we explored the trends of incidence and the odds of
case fatality after versus before the January 1, 2014 Medicaid expansion.
Overall, 93,423 emergency cholecystectomies were performed, with 644 fatalities; 87,239 ambulatory cholecystectomies were performed, with fewer than 10 fatalities. The 2009 to 2018 annual incidence of emergency cholecystectomies dropped markedly from 114.8 to 77.5 per 100,000 NJ population (P < 0.0001); ambulatory cholecystectomies increased from 93.5 to 95.6 per 100,000 (P = 0.053). The incidence of emergency cholecystectomies dropped more after than before Medicaid expansion (P < 0.0001). The odds ratio for case fatality among those undergoing emergency cholecystectomies after versus before expansion was 0.85 (95% CI, 0.72-0.99). This decrease in
case fatality, apparent only in those over age 65, was not explained by the addition of Medicaid.
A marked decrease in the incidence of emergency cholecystectomies occurred after Medicaid expansion, which was not accounted for by a minimal increase in the incidence of ambulatory cholecystectomies.
Case fatality from emergency cholecystectomy decreased over time due to factors other than Medicaid. Further work is needed to reconcile these findings with the previously reported lack of decrease in overall gallstone disease mortality in NJ.