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      Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis

      1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 12 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 3 , 14 , 23 , 24 , 25 , 26 , 27 , 18 , 28 , 29 , 3 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 13 , 38 , 13 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 7 , 49 , 50 , 51 , 29
      Journal of Hepato-Biliary-Pancreatic Sciences
      Wiley

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          Abstract

          We propose a new flowchart for the treatment of acute cholecystitis (AC) in the Tokyo Guidelines 2018 (TG18). Grade III AC was not indicated for straightforward laparoscopic cholecystectomy (Lap-C). Following analysis of subsequent clinical investigations and drawing on Big Data in particular, TG18 proposes that some Grade III AC can be treated by Lap-C when performed at advanced centers with specialized surgeons experienced in this procedure and for patients that satisfy certain strict criteria. For Grade I, TG18 recommends early Lap-C if the patients meet the criteria of Charlson comorbidity index (CCI) ≤5 and American Society of Anesthesiologists physical status classification (ASA-PS) ≤2. For Grade II AC, if patients meet the criteria of CCI ≤5 and ASA-PS ≤2, TG18 recommends early Lap-C performed by experienced surgeons; and if not, after medical treatment and/or gallbladder drainage, Lap-C would be indicated. TG18 proposes that Lap-C is indicated in Grade III patients with strict criteria. These are that the patients have favorable organ system failure, and negative predictive factors, who meet the criteria of CCI ≤3 and ASA-PS ≤2 and who are being treated at an advanced center (where experienced surgeons practice). If the patient is not considered suitable for early surgery, TG18 recommends early/urgent biliary drainage followed by delayed Lap-C once the patient's overall condition has improved. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

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          A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation

          The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.
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            Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.

            Implementation of the International Statistical Classification of Disease and Related Health Problems, 10th Revision (ICD-10) coding system presents challenges for using administrative data. Recognizing this, we conducted a multistep process to develop ICD-10 coding algorithms to define Charlson and Elixhauser comorbidities in administrative data and assess the performance of the resulting algorithms. ICD-10 coding algorithms were developed by "translation" of the ICD-9-CM codes constituting Deyo's (for Charlson comorbidities) and Elixhauser's coding algorithms and by physicians' assessment of the face-validity of selected ICD-10 codes. The process of carefully developing ICD-10 algorithms also produced modified and enhanced ICD-9-CM coding algorithms for the Charlson and Elixhauser comorbidities. We then used data on in-patients aged 18 years and older in ICD-9-CM and ICD-10 administrative hospital discharge data from a Canadian health region to assess the comorbidity frequencies and mortality prediction achieved by the original ICD-9-CM algorithms, the enhanced ICD-9-CM algorithms, and the new ICD-10 coding algorithms. Among 56,585 patients in the ICD-9-CM data and 58,805 patients in the ICD-10 data, frequencies of the 17 Charlson comorbidities and the 30 Elixhauser comorbidities remained generally similar across algorithms. The new ICD-10 and enhanced ICD-9-CM coding algorithms either matched or outperformed the original Deyo and Elixhauser ICD-9-CM coding algorithms in predicting in-hospital mortality. The C-statistic was 0.842 for Deyo's ICD-9-CM coding algorithm, 0.860 for the ICD-10 coding algorithm, and 0.859 for the enhanced ICD-9-CM coding algorithm, 0.868 for the original Elixhauser ICD-9-CM coding algorithm, 0.870 for the ICD-10 coding algorithm and 0.878 for the enhanced ICD-9-CM coding algorithm. These newly developed ICD-10 and ICD-9-CM comorbidity coding algorithms produce similar estimates of comorbidity prevalence in administrative data, and may outperform existing ICD-9-CM coding algorithms.
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              Validation of a combined comorbidity index

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                Author and article information

                Journal
                Journal of Hepato-Biliary-Pancreatic Sciences
                J Hepatobiliary Pancreat Sci
                Wiley
                18686974
                January 2018
                January 2018
                December 20 2017
                : 25
                : 1
                : 55-72
                Affiliations
                [1 ]Department of Surgery; Center for Gastroenterology and Liver Disease; Kitakyushu City Yahata Hospital; Fukuoka Japan
                [2 ]Department of Surgery; Fujinomiya City General Hospital; Shizuoka Japan
                [3 ]Department of Surgery; Teikyo University School of Medicine; Tokyo Japan
                [4 ]Section of Hepato-Pancreato-Biliary Surgery; Washington University School of Medicine in St. Louis; St. Louis MO USA
                [5 ]Department of Surgery; Mayo Clinic College of Medicine; Jacksonville FL USA
                [6 ]Department of Gastroenterological Surgery; Yokohama City University Graduate School of Medicine; Kanagawa Japan
                [7 ]Department of Gastroenterological and Pediatric Surgery; Oita University Faculty of Medicine; Oita Japan
                [8 ]Department of Surgery; Keio University School of Medicine; Tokyo Japan
                [9 ]Lewis Katz School of Medicine at Temple University; Philadelphia PA USA
                [10 ]Minimally Invasive Surgery Center; Yotsuya Medical Cube; Tokyo Japan
                [11 ]Department of Surgery; Toho University Ohashi Medical Center; Tokyo Japan
                [12 ]Department of Surgery; Seoul National University Bundang Hospital; Seoul National University College of Medicine; Seoul Korea
                [13 ]Division of General Surgery; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan
                [14 ]Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
                [15 ]Department of Surgery; Show Chwan Memorial Hospital; Changhua Taiwan
                [16 ]Department of General and HPB Surgery; Loreto Nuovo Hospital; Naples Italy
                [17 ]First Department of Surgery; Agia Olga Hospital; Athens Greece
                [18 ]Department of General Internal Medicine; Japanese Red Cross Nagoya Daini Hospital; Aichi Japan
                [19 ]Department of Gastroenterology; Ogaki Municipal Hospital; Gifu Japan
                [20 ]Department of Gastroenterology and Hepatology; Tokyo Medical University Hospital; Tokyo Japan
                [21 ]Department of Surgical Oncology; Lilavati Hospital and Research Centre; Mumbai India
                [22 ]Clinical Surgery; University of Edinburgh; Edinburgh UK
                [23 ]Department of Gastroenterological Surgery; Fujita Health University School of Medicine; Aichi Japan
                [24 ]Department of Surgery; Ageo Central General Hospital; Saitama Japan
                [25 ]Hepatobiliary Center; Paul Brousse Hospital; Villejuif France
                [26 ]Department of Surgery, Hospital Italiano; University of Buenos Aires; Buenos Aires Argentina
                [27 ]Director; Mie Prefectural Ichishi Hospital; Mie Japan
                [28 ]Department of Family Medicine; Mie Prefectural Ichishi Hospital; Mie Japan
                [29 ]Department of Surgery; Institute of Gastroenterology; Tokyo Women's Medical University; Tokyo Japan
                [30 ]Department of Surgery; Tokyo Metropolitan Komagome Hospital; Tokyo Japan
                [31 ]Department of Surgical Gastroenterology; Seth G S Medical College and K E M Hospital; Mumbai, India
                [32 ]Department of Hemodialysis and Surgery; Ichikawa Hospital; International University of Health and Welfare; Chiba Japan
                [33 ]Department of EBM and Guidelines; Japan Council for Quality Health Care; Tokyo Japan
                [34 ]Department of Emergency Medicine; School of Medicine; University of Occupational and Environmental Health; Fukuoka Japan
                [35 ]Department of Surgery; Academic Medical Center; Amsterdam The Netherlands
                [36 ]Department of Surgery; Rush University Medical Center; Chicago IL USA
                [37 ]Liau KH Consulting PL; Mt Elizabeth Novena Hospital; Singapore Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
                [38 ]Department of Surgery 1; School of Medicine; University of Occupational and Environmental Health; Fukuoka Japan
                [39 ]Department of Surgery; Cheng Hsin General Hospital; Taipei Taiwan
                [40 ]Surgery Centre; Department of Surgery; Hong Kong Sanatorium and Hospital; Hong Kong Hong Kong
                [41 ]Department of Surgery; Yonsei University Gangnam Severance Hospital; Seoul Korea
                [42 ]Department of Surgery; Konyang University Hospital; Daejeon Korea
                [43 ]Surgical Gastroenterology/Hepatopancreatobiliary Unit; University of Cape Town and Groote Schuur Hospital; Cape Town South Africa
                [44 ]Hepatic Surgery Centre; Department of Surgery; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
                [45 ]Director; Liver Surgery Centre; Hong Kong Sanatorium and Hospital; Hong Kong Hong Kong
                [46 ]Department of Surgery; Yuan's General Hospital; Kaohsiung Taiwan
                [47 ]Chair of General Surgery and Minimal Invasive Surgery “Taquini”; University of Buenos Aires; DAICIM Foundation; Buenos Aires Argentina
                [48 ]President; Oita University; Oita Japan
                [49 ]Department of Surgery; JR Sapporo Hospital; Hokkaido Japan
                [50 ]Department of Gastroenterology; Second Teaching Hospital; Fujita Health University; Aichi Japan
                [51 ]Director; Toho University; Tokyo Japan
                Article
                10.1002/jhbp.516
                29045062
                21515cb6-183b-4090-9064-750a11ef95f5
                © 2017

                http://doi.wiley.com/10.1002/tdm_license_1.1

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