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1.
BMJ Open Gastroenterol ; 10(1)2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37562856

RESUMO

OBJECTIVE: For acute cholecystitis, the treatment of choice is laparoscopic cholecystectomy. In mild-to-moderate cases, the use of antibiotic prophylaxis for the prevention of postoperative infectious complications (POICs) lacks evidence regarding its cost-effectiveness when compared with no prophylaxis. In the context of rising antimicrobial resistance, there is a clear rationale for a cost-effectiveness analysis (CEA) to determine the most efficient use of National Health Service resources and antibiotic routine usage. DESIGN: 16 of 226 patients (7.1%) in the single-dose prophylaxis group and 29 of 231 (12.6%) in the non-prophylaxis group developed POICs. A CEA was carried out using health outcome data from thePerioperative antibiotic prophylaxis in the treatment of acute cholecystitis (PEANUTS II) multicentre, randomised, open-label, non-inferiority, clinical trial. Costs were measured in monetary units using pound sterling, and effectiveness expressed as POICs avoided within the first 30 days after cholecystectomy. RESULTS: This CEA produced an incremental cost-effectiveness ratio of -£792.70. This suggests a modest cost-effectiveness of antibiotic prophylaxis being marginally less costly and more effective than no prophylaxis. Three sensitivity analyses were executed considering full adherence to the antibiotic, POICs with increased complexity and break-point analysis suggesting caution in the recommendation of systematic use of antibiotic prophylaxis for the prevention of POICs. CONCLUSION: The results of this CEA point to greater consensus in UK-based guidelines surrounding the provision of antibiotic prophylaxis for mild-to-moderate cases of acute cholecystitis.


Assuntos
Colecistite Aguda , Análise de Custo-Efetividade , Humanos , Medicina Estatal , Antibacterianos/uso terapêutico , Colecistectomia , Complicações Pós-Operatórias/prevenção & controle , Colecistite Aguda/cirurgia , Colecistite Aguda/tratamento farmacológico
2.
Ann Surg ; 258(3): 385-93, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24022431

RESUMO

OBJECTIVE: Acute cholecystitis is a common disease, and laparoscopic surgery is the standard of care. BACKGROUND: Optimal timing of surgery for acute cholecystitis remains controversial: either early surgery shortly after hospital admission or delayed elective surgery after a conservative treatment with antibiotics. METHODS: The ACDC ("Acute Cholecystitis-early laparoscopic surgery versus antibiotic therapy and Delayed elective Cholecystectomy") study is a randomized, prospective, open-label, parallel group trial. Patients were randomly assigned to receive immediate surgery within 24 hours of hospital admission (group ILC) or initial antibiotic treatment, followed by delayed laparoscopic cholecystectomy at days 7 to 45 (group DLC). For infection, all patients were treated with moxifloxacin for at least 48 hours. Primary endpoint was occurrence of predefined relevant morbidity within 75 days. Secondary endpoints were as follows: (1) 75-day morbidity using a scoring system; (2) conversion rate; (3) change of antibiotic therapy; (4) mortality; (5) costs; and (6) length of hospital stay. RESULTS: Morbidity rate was significantly lower in group ILC (304 patients) than in group DLC (314 patients): 11.8% versus 34.4%. Conversion rate to open surgery and mortality did not differ significantly between groups. Mean length of hospital stay (5.4 days vs 10.0 days; P < 0.001) and total hospital costs (€2919 vs €4262; P < 0.001) were significantly lower in group ILC. CONCLUSIONS: In this large, randomized trial, laparoscopic cholecystectomy within 24 hours of hospital admission was shown to be superior to the conservative approach concerning morbidity and costs. Therefore, we believe that immediate laparoscopic cholecystectomy should become therapy of choice for acute cholecystitis in operable patients. (NCT00447304).


Assuntos
Colecistectomia Laparoscópica/métodos , Colecistite Aguda/cirurgia , Adulto , Idoso , Antibacterianos/economia , Antibacterianos/uso terapêutico , Compostos Aza/economia , Compostos Aza/uso terapêutico , Colecistectomia Laparoscópica/economia , Colecistite Aguda/tratamento farmacológico , Colecistite Aguda/economia , Colecistite Aguda/mortalidade , Terapia Combinada , Conversão para Cirurgia Aberta/estatística & dados numéricos , Análise Custo-Benefício , Esquema de Medicação , Feminino , Fluoroquinolonas , Alemanha , Custos Hospitalares/estatística & dados numéricos , Humanos , Análise de Intenção de Tratamento , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Moxifloxacina , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Quinolinas/economia , Quinolinas/uso terapêutico , Eslovênia , Fatores de Tempo , Resultado do Tratamento
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