The Care Processes for Acute Cholecystitis According to Clinical Practice Guidelines Based on the Japanese Administrative Database

Abstract

Acute cholecystitis is one of the most frequently encountered conditions in daily practice in Japan. However, there is a shortage of detailed data about treatments that have been performed according to the clinical practice guidelines (CPGs) for acute cholecystitis. We therefore examined the management of acute cholecystitis for adherence to the appropriate CPGs using the Japanese administrative database associated with the Diagnosis Procedure Combination (DPC) system. We collected data from 6,070 patients with acute cholecystitis, examining for the application of four recommended treatments (administration of antimicrobial drugs and nonsteroidal anti-inflammatory drugs (NSAIDs) and performance of early and laparoscopic cholecystectomy). The patients were classified according to the procedures documented for each case: no gallbladder drainage (n = 4,333), gallbladder drainage without supportive care (ventilation or hemodiafiltration or the use of vasopressor) (n = 1,591) and gallbladder drainage and supportive care (n = 146). Multiple logistic regression models revealed that patients with gallbladder drainage without supportive care and those with gallbladder drainage and supportive care significantly higher received administration of antimicrobial drugs and NSAIDs, while these patients underwent less early or laparoscopic cholecystectomy than did patients without gallbladder drainage, after adjusting for potential confounding effects of the clinical variables. This study demonstrated that there were various differences with regard to the performance of recommended treatments between the levels of procedures required for acute cholecystitis. In addition, this administrative database was a feasible tool for the evaluation of care processes and will provide useful information contributing to improved quality of medical care.

Age-Related Differences in Outcomes and Etiologies of Acute Abdominal Pain Based on a National Administrative Database

“…The DPC system was introduced into 82 academic hospitals in 2003 (Murata et al 2010(Murata et al , 2012. Insurance reimbursements using the DPC system are widespread in Japan, and the administrative database of the DPC system has increased the representation of acute care hospitals over time.…”

“…Insurance reimbursements using the DPC system are widespread in Japan, and the administrative database of the DPC system has increased the representation of acute care hospitals over time. As of 2007, data from approximately 450,000 inpatients have been compiled, representing approximately 90% of all acute care inpatient hospitalizations in Japan (Murata et al 2010(Murata et al , 2012. The DPC administrative database includes each patient's discharge summary and claim information, including principal diagnosis (disease which triggered admission or main disease on discharge), comorbidities at the time of admission, and complications during hospitalization .…”

“…These codes are determined by the Ministry of Health, Labour and Welfare of Japan. The DPC database also includes the quantity and date of all care delivered on a daily basis during hospitalization (Murata et al 2010(Murata et al , 2012.…”

“…These hospitals are situated throughout Japan and play leading roles in providing acute care medicine, advancing medical research, and educating students and medical residents (Murata et al 2010(Murata et al , 2012. The principal diagnosis of acute abdominal pain was recorded using the ICD-10th code.…”

“…The CCI was expressed as the score of comorbid conditions and initially evaluated as a continuous variable. The categorical variables of CCI defining four categories for the severity of the comorbid conditions were created to simplify the presentation of the results: 0 and 1, mild; 2, moderate; and 3 or more, severe (Murata et al 2010(Murata et al , 2012. The presence of surgical treatments for patients was determined by the data of the operation code.…”