Analysis of the factors influencing delayed diagnosis of elderly patients with acute cholecystitis ZHANG
Ri -yuan,CHEN Wei -ling,ZHENG Su -hua
Department of Hepatobiliary and Pancreatic Surgery,Pingyang Affiliated Hospital, Wenzhou Medical University, Wenzhou325400,China
Abstract:
Objective To explore the factors that contribute to the delayed diagnosis of acute cholecystitis in the elderly and provide valuable insights for clinical practice. Methods A retrospective analysis was conducted on 135 elderly patients who were diagnosed with acute cholecystitis between March 2021 and March 2023 in our hospital. Based on the time of diagnosis, the patients were divided into two groups: a delayed diagnosis group(diagnosed after 3 days) and an undelayed diagnosis group (diagnosed within 3 days). The study analyzed the factors that influenced the delayed diagnosis of acute cholecystitis in the elderly using a logistic regression model.Additionally, a column line graph prediction model was constructed to predict the delayed diagnosis of acute cholecystitis in the elderly. The ROC curve was used to evaluate the predictive value of each indicator for the delayed diagnosis of acute cholecystitis in the elderly. Results Several factors were associated with delayed diagnosis of acute cholecystitis in the elderly. These factors include age 80 years (OR=3.279, 95%CI: 1.117~9.606, P=0.032), male gender (OR=3.031, 95%CI: 1.233~7.446, P=0.016), serum albumin level (OR=0.291, 95% CI: 0.120~0.712, P= 0.006), body mass index (BMI) (OR=1.408, 95%CI: 1.061~1.869, P=0.020), and lack of abdominal pain (OR=2.788, 95%CI: 1.219~6.364, P=0.019). The combined diagnosis of these five indicators had good diagnostic value in predicting the occurrence of delayed diagnosis of acute cholecystitis in the elderly, with an area under the receiver operating characteristic curve (AUC) of 0.98 (95%CI: 0.96~0.99), sensitivity of 92.94%,specificity of 91.72%, and an odds ratio of 0.85. Conclusion Patients who are 80 years or older, male, have low serum albumin levels, higher BMI (BMI>25 kg/m2), and no abdominal pain are more likely to experience adelayed diagnosis of acute cholecystitis. Clinicians should consider these factors to enhance the accuracy of diagnosis and minimize the risk of delayed diagnosis.
