86 Acalculous Cholecystitis: Changing Trends From 2004 to 2014

Abstract

INTRODUCTION: Acute acalculous cholecystitis (AAC) which accounts for 10% cases of cholecystitis is associated with high morbidity and mortality rates. The management options for AAC range from surgical removal of the gall bladder to emergent drainage either by percutaneous means or endoscopically. Data about the in-hospital outcomes of AAC is sparse. METHODS: The NIS is the largest all-payer inpatient database in the United States and contains data from approximately 8 million hospital stays each year. We analyzed the National Inpatient Sample Database (NIS) for all patients in which acute acalculous cholecystitis (ICD-9 codes: 575.0, 575.1) was the principal discharge diagnosis from 2004 to 2014. We further looked at procedure codes Endoscopic retrograde cholangiopancreatography (ERCP), Endoscopic ultrasound (EUS), Percutaneous transhepatic cholangiography (PTC), open and laparoscopic cholecystectomy. The outcome variables were in hospital mortality, length of stay and total hospital charge. Univariate and multivariate analysis was performed adjusted for multiple confounder. RESULTS: In 2014 there were 35865 hospital admissions with the principal diagnosis AAC which increased significantly from 23485 in 2004 (P < 0.001). The mean length of stay for acute cholecystitis decreased by 21.6% between 2004 and 2014 (i.e., from 5.1 days to 4.0 days; (P < 0.05). During the same time period, however, mean hospital charges have increased by 190.5% from US$24 514 per patient in 2004 to US$46847 per patient in 2014 (P < 0.001). There were no cases of EUS guided drainage in 2004 while in 2014 there were 485 cases. A significantly higher proportion of patients received PTC, ERCP and laparoscopic cholecystectomy in 2014 compared to 2004 (P = 0.001). The in-hospital mortality declined from 1.4% in 2004 to 0.9% in 2014. Factors associated with in-hospital mortality were Diabetes mellitus (OR = 1.76, P = 0.004), presence of Chronic kidney disease (OR = 2.36, P = 0.003), hematologic malignancy (OR = 4.5, P < 0.001) and metastatic cancer (OR = 14.56, P < 0.0001). CONCLUSION: The number of cases of acalculous cholecystitis has shown a gradual increase from 2004 to 2014. However there has been a gradual reduction in mortality and length of stay in these patients. While it is associated with increased utilization of ERCP and EUS, causality cannot definitively be established.