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J Korean Soc Emerg Med > Volume 33(3); 2022 > Article
Journal of The Korean Society of Emergency Medicine 2022;33(3): 279-287.
응급실에 내원한 담관염을 동반한 총담관 폐쇄 환자에서 신속처리과정 도입이 예후에 미치는 영향
이상용1 , 장성일2 , 정성필1 , 이혜선3 , 전소영3 , 유제성1 , 공태영1 , 범진호1 , 고동률1
1연세대학교 의과대학 응급의학교실
2연세대학교 의과대학 강남세브란스병원 내과학교실
3연세대학교 의과대학 연구부 통계지원팀
Effect of fast track on prognosis in patients with common bile duct obstruction with cholangitis in emergency department
Sang Yong Lee1 , Sung Ill Jang2 , Sung Phil Chung1 , Hye Sun Lee3 , Soyoung Jeon3 , Je Sung You1 , Tae Young Kong1 , Jin Ho Beom1 , Dong Ryul Ko1
1Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
2Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
3Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
Correspondence  Dong Ryul Ko ,Tel: 02-2019-3030, Fax: 02-2019-4820, Email: kkdry@yuhs.ac,
Received: June 30, 2021; Revised: September 29, 2021   Accepted: October 26, 2021.  Published online: June 30, 2022.
ABSTRACT
Objective:
Biliary decompression through bile drainage is a key treatment for common bile duct obstruction with cholangitis. However, the effectiveness of early interventions has not been studied sufficiently in Korea. This study investigated the effectiveness of fast-track biliary decompression.
Method:
A group of patients diagnosed with common bile duct obstruction with cholangitis between January 1, 2014, and December 31, 2019, was reviewed retrospectively. We divided them into two groups: before and after the implementation of fast-track biliary decompression. The following items were analyzed in the two groups: time to intervention, number of hospital days, length of stay in the emergency department, and intensive care unit (ICU) admission.
Results:
Between January 1, 2014, and December 31, 2019, 418 patients were admitted for common bile duct obstruction, and a total of 369 patients were included in this study. Of these, 168 patients visited the hospital prior to implementation of the treatment, and 201 patients visited after implementation. The time to intervention was 6.1 (4.2-11.0) hours in the fast-track group, which was about 9 hours shorter than the other group (P<0.001). There was no statistical difference in the number of hospital days, emergency department length of stay, and ICU admissions (P=0.535, P=0.034, P=0.322).
Conclusion:
The time to intervention was shortened significantly in the fast-track group. However, we did not observe a significant improvement in patient prognosis. It may be possible that the procedure time may need to be shortened for a better prognosis. This should be investigated in future studies.
Key words: Common bile duct obstruction; Cholangitis; Mortality
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