- 作者：Benjamin K. ; Poulose M.D. ; M.P.H.&lowast ; ; ; benjamin.poulose@vanderbilt.edu ; Sharon ; Phillips M.S.P.H.&dagger ; ; William ; Nealon M.D.&lowast ; ; Julia ; Shelton M.D.&lowast ; ; Kristy ; Kummerow M.D.&lowast ; ; David ; Penson M.D. ; M.P.H.&Dagger ; ; Michael D. ; Holzman M.D. ; M.P.H.&lowast ;
- 关键词：access to care ; rural surgery ; choledocholithiasis ; common bile duct ; endoscopic retrograde cholangiography
- 刊名：Journal of Surgical Research
- 出版年：2011
- 出版时间：October 2011
- 年：2011
- 卷：170
- 期：2
- 页码：214-219
- 全文大小：237 K
Background
Choledocholithiasis (CDL) management is dictated by local expertise, individual training, and availability of appropriate staff. This study evaluates the management of CDL between urban and rural communities.Materials and Methods
Patients undergoing inpatient management of CDL were identified from the 2007 Healthcare Cost and Utilization Project. Availability of endoscopic retrograde cholangiopancreatography (ERCP) was determined from the 2007 American Hospital Association survey. The proportion of common bile duct exploration (CBDE), ERCP, or percutaneous (PERC) interventions were compared across census regions and National Centers for Health Statistics (NCHS) urban¨Crural classes. The NCHS urban¨Crural?classification scheme divides counties from most populous (NCHS 1) to rural (NCHS 6). Proportions were compared using the 95 % confidence interval (95 % CI) approach.
Results
We estimated 111,021 CDL hospitalizations in the U.S. in 2007. Of these, 67 % had a coded intervention. Intervention frequencies were similar across census regions. Comparisons across NCHS classes revealed higher proportions of ERCP in urban areas (NCHS 1?) while a higher proportion of CBDE was seen in rural areas (NCHS 5?). ERCP availability was high in metropolitan areas (available in 35 % ?4 % of hospitals NCHS 1?) and low in rural areas (25 % of NCHS 5 hospitals and 5 % NCHS 6). PERC management was similar across NCHS classes.
Conclusions
Rural hospitals and communities need surgeons trained in CBDE, where ERCP expertise may not be readily available. Feasible ways of expanding ERCP coverage to the nation¡¯s rural areas need to be explored. These observations may impact surgical training at least for those targeting careers in rural surgery.