Tohoku J. Exp. Med., 2012, 227(4)

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

ATSUHIKO MURATA,¹ KOHJI OKAMOTO,² SHINYA MATSUDA,¹ KAZUAKI KUWABARA,³ YUKAKO ICHIMIYA,¹ YASUFUMI MATSUDA,¹ TATSUHIKO KUBO,¹ YOSHIHISA FUJINO,¹ KENJI FUJIMORI⁴ and HIROMASA HORIGUCHI⁵

¹Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyusyu, Japan
²Department of Surgery, Yahata Municipal Hospital, Kitakyushu, Japan
³Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

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.

keywords —— acute cholecystitis; administrative database; care processes; clinical practice guidelines; diagnosis procedure combination

© 2012 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2012, 227, 237-244

Correspondence: Atsuhiko Murata, M.D., Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.

e-mail: amurata@med.uoeh-u.ac.jp