100 Outcomes of Acute Pancreatic in Patients With and Without History of Cholecystectomy

Abstract

INTRODUCTION: Acute pancreatitis (AP) has been shown to have a high mortality of up to 21%. But, data are lacking on the mortality and other outcomes in patients who underwent cholecystectomy. We aimed to assess the outcomes of AP in patients who had history of cholecystectomy versus who retained their gall bladder. METHODS: Using data from the National Inpatient Sample (NIS) database between 2002 and 2014, we identified patients who were diagnosed with AP using appropriate ICD 9 coding. Patients with AP were divided into two groups: with history of cholecystectomy (study group) and without history of cholecystectomy (control group). We then performed multivariate logistic regression analysis to compare the outcomes of AP between the two groups. Outcomes of interest included: inpatient mortality (IM), respiratory failure (RF) and acute kidney injury (AKI). RESULTS: A total of 1,094,214 total patients with AP were identified, of which 18,263 patients (1.67%) had history of cholecystectomy. Patients with cholecystectomy were older (53 vs 52), more likely to female (56.6% vs 49.9%) and less likely to be African American (11% vs 16.6%) than the control group (P < 0.001 for all). In addition, patients with cholecystectomy had less alcohol abuse (12.8% vs 22.8%, P < 0.001) but more likely to be obese (13.1% vs 9.4%) and smokers (23.1% and 19.4%) when compared to the control group (P < 0.001) (Table 1). Using Multivariate logistic regression, and after adjusting for potential cofounding factors including (age, race, gender, obesity, alcohol abuse, smoking and Elixhauser comorbidities), individuals in the cholecystectomy group had a lower rate of in-patient mortality (IM) (OR 0.21, 95%, CI: 0.16–0.28, P < 0.001), respiratory failure (RF) (OR 0.30, 95%, CI: 0.26–0.34, P < 0.001) and acute kidney injury (OR 0.58, 95%, CI: 0.54–0.63, P < 0.001) when compared to patients without cholecystectomy (Figure 1). CONCLUSION: Our study suggests that cholecystectomy in patients admitted with acute pancreatitis is associated with lower risk of IM, RF and AKI and should be considered in all patients admitted with acute pancreatitis.