Abstract
Biliary tract diseases that are not adequately treated on index hospitalization are linked to worse outcomes, including high readmission rates. Delays in care for conditions such as choledocholithiasis, gallstone pancreatitis, and cholecystitis often occur due to multiple reasons, and this delay is under-appreciated as a source of morbidity and mortality. Our study is based on the latest Nationwide Readmissions Database review and evaluated the effects of postponing definitive management to a subsequent visit. The study shows a higher 30-day readmission rate in addition to increased mortality rate, intubation rate, vasopressor use in this patient population and significantly added financial burden.
Highlights
Cholecystitis, choledocholithiasis and acute biliary pancreatitis represent a spectrum of biliary diseases that warrant evaluation for cholecystectomy on index hospitalization
This study shows the financial and economic burden that stems from readmissions resulting from not performing cholecystectomy on the index hospitalization and the high morbidity and mortality associated with it
Of those discharged after index hospitalization without having received cholecystectomy, within the parameters of our study described in Figure 1, 12.24% are readmitted
Summary
Cholecystitis, choledocholithiasis and acute biliary pancreatitis (acute gallstone-related diseases) represent a spectrum of biliary diseases that warrant evaluation for cholecystectomy on index hospitalization. Several metanalysis showed interval cholecystectomy after mild biliary pancreatitis is associated with high risk of readmission for recurrent biliary events [4,5,6]. Prospective randomized studies showed that index admission laparoscopic cholecystectomy in mild to moderate acute biliary pancreatitis reduced the risk for recurrent attacks and was not linked to increased operative challenges or morbidity in the peri-operative period [7,8,9,10]. For cases of acute cholecystitis, an early laparoscopic cholecystectomy has been associated with reduced length of hospitalization and no significant perioperative complications [11,12,13,14,15,16,17]. Similar findings are found in biliary colic and choledocholithiasis [18,19,20]
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