Burden of gallstone disease in the United States population:Prepandemic rates and trends

BACKGROUND Gallstone disease is one of the most common digestive disorders in the United States and leads to significant morbidity,mortality,and health care utilization.AIM To expand on earlier findings and investigate prepandemic rates and trends in the gallstone disease burden in the United States using national survey and claims databases.METHODS The National Ambulatory Medical Care Survey,National Inpatient Sample,Nationwide Emergency Department Sample,Nationwide Ambulatory Surgery Sample,Vital Statistics of the United States,Optum Clinformatics®Data Mart,and Centers for Medicare and Medicaid Services Medicare 5%Sample and Medicaid files were used to estimate claims-based prevalence,medical care including cholecystectomy,and mortality with a primary or other gallstone diagnosis.Rates were age-adjusted(for national databases)and shown per 100000 population.RESULTS Gallstone disease prevalence(claims-based,2019)was 0.70%among commercial insurance enrollees,1.03%among Medicaid beneficiaries,and 2.09%among Medicare beneficiaries and rose over the previous decade.Recently,in the United States population,gallstone disease contributed to approximately 2.2 million ambulatory care visits,1.2 million emergency department visits,625000 hospital discharges,and 2000 deaths annually.Women had higher medical care rates with a gallstone disease diagnosis,but mortality rates were higher among men.Hispanics had higher ambulatory care visit and hospital discharge rates compared with Whites,but not mortality rates.Blacks had lower ambulatory care visit and mortality rates,but similar hospital discharge rates compared with whites.During the study period,ambulatory care and emergency department visit rates with a gallstone disease diagnosis rose,while hospital discharge and mortality rates declined.Among commercial insurance enrollees,rates were higher compared with national data for ambulatory care visits and hospitalizations,but lower for emergency department visits.Cholecystectomies performed in the United States included 605000 ambulatory laparoscopic,280000 inpatient laparoscopic,and 49000 inpatient open procedures annually.Among commercial insurance enrollees,rates were higher compared with national data for laparoscopic procedures.CONCLUSION The gallstone disease burden in the United States is substantial and increasing,particularly among women,Hispanics,and older adults with laparoscopic cholecystectomy as the mainstay treatment.Current practice patterns should be monitored for better health care access.

“One-day,one-stay,and one-step”lessons from the Danish guidelines for the treatment of gallstone disease

Introduction.Gallstone disease is prevalent worldwide,and the incidence in Europe increased over the last decades.The median prevalence ranges from 5.9%to 21.9%,with the highest rates seen in Norway(21.9%)and the eastern part of Germany(19.7%)and the lowest rates in Italy(<7%)(1).In The Netherlands,over 100,000 patients are diagnosed with symptomatic gallstones annually,costing around 250 million euros,ranking gallstones disease in the top 10 of the most prevalent and costly gastrointestinal disorders(2).

Awake laparoscopic cholecystectomy:A case report and review of literature

BACKGROUND Laparoscopic cholecystectomy(LC)is one of the most widely practiced surgical procedures in abdominal surgery.Patients undergo LC during general anaesthesia;however,in recent years,several studies have suggested the ability to perform LC in patients who are awake.We report a case of awake LC and a literature review.CASE SUMMARY A 69-year-old patient with severe pulmonary disease affected by cholelithiasis was scheduled for LC under regional anaesthesia.We first performed peridural anaesthesia at the T8-T9 level and then spinal anaesthesia at the T12-L1 level.The procedure was managed in total comfort for both the patient and the surgeon.The intra-abdominal pressure was 8 mmHg.The patient remained stable throughout the procedure,and the postoperative course was uneventful.CONCLUSION Evidence has warranted the safe use of spinal and epidural anaesthesia,with minimal side effects easily managed with medications.Regional anaesthesia in selected patients may provide some advantages over general anaesthesia,such as no airway manipulation,maintenance of spontaneous breathing,effective postoperative analgesia,less nausea and vomiting,and early recovery.However,this technique for LC is not widely used in Europe;this is the first case reported in Italy in the literature.Regional anaesthesia is feasible and safe in performing some types of laparoscopic procedures.Further studies should be carried out to introduce this type of anaesthesia in routine clinical practice.

老年胆石症患者的治疗:手术与非手术治疗的比较

背景:本研究旨在评估内镜逆行胆胰管造影术(ERCP)、ERCP+胆囊切除术(EC)和经皮抽吸术(PA)三种方法治疗老年胆总管结石患者的疗效。方法:研究纳入43,338例老年(≥60岁)和45,295例年龄<60岁的胆总管结石病例。病例来自美国全国住院样本库2011-2014年间因胆石并发症入院的病例,其诊断基于ICD 9。采用多因素逻辑回归模型计算住院死亡的风险,并比较各治疗组(ERCP、EC、PA)、各年龄组(<60岁、60-69岁、70-79岁、≥80岁)及性别组的差异。采用单变量线性回归模型比较各年龄组间住院时间和再入院频率的差异。结果:在排除治疗方式的影响后,患者年龄会影响病死率和住院时间。在各个年龄组中,PA组均有最高的死亡风险和最长的住院时间,而EC组病死率最低,ERCP组住院时间最短。年龄和治疗方式均不影响再住院率。性别不影响病死率和再住院率。然而,在60-69岁的患者中,女性住院时间更短。结论:患者年龄越大,胆总管结石及其相关并发症的治疗效果越差。无论是什么年龄段的胆石症患者,胆囊切除术可能都是一种有效的治疗方法。