Is There Disparity in Index-Admission Cholecystectomy for Mild Acute Biliary Pancreatitis in Patients With Morbid Obesity: A National Survey

Abstract

Introduction: Gallstone is the leading cause of acute pancreatitis (AP) and obesity is a risk factor for gallstone formation. Major society guidelines have recommended same admission cholecystectomy (CCY) for mild acute biliary pancreatitis (ABP). There has been reported disparity regarding obese patient receiving standard medical care from routine cancer screening to end of life care. We sought to determine if there is a disparity in performance of index-admission CCY in patients admitted with mild ABP. Methods: The National Readmission Database (2010-2014) was reviewed to identify adult inpatients (≥18years) with a principal diagnosis of ABP (AP with gallstones). Only patients with mild ABP were included. Study flow is shown in Figure 1. The primary outcome was index-admission CCY and secondary outcomes included post-CCY complication, 30-day readmission and hospital cost. Univariate, multivariate, and propensity score-matched analyses was performed to compare the morbidly obese and non-obese cohorts.1023_A Figure 1. Study Flow Chart: Showing exclusion criteria, primary and secondary outcome in the study.Results: There were 150,884 patients (non-obese 136,332, morbid obese 14,552) with mild ABP during the study period. Patients with morbid obesity were younger (46.7 vs 56.3 years, p001), predominantly female (71.6% vs 62.4%, p < .001), and had more comorbidities (32% vs 27.5% p < .001) compared to the nonobese cohort (Table 1). After propensity score-matched analysis, morbid obesity cohort with mild ABP had a higher indexadmission CCY rate (60.9% vs 58.3% p= 0.01), longer hospital stay (3.5 vs 3.2 days p < .001), and higher hospital cost (IQR: $10,237 vs $9,326 p < .001) but similar post-CCY complication rate (2.1% vs 1.9% p=0.13) and 30-day readmission rate (5.4% vs 5.0% p=0.5) compared to the non-obese cohort (Table 1). Conclusion: This national survey demonstrates a lack of disparity in index-admission CCY for patients with morbid obesity when admitted with mild ABP. Further, the clinical outcomes of CCY related post-operative complication and 30-day readmission in patients with morbid obesity are comparable to the non-obese cohort further reinforcing adherence to current guidelines.1023_B Figure 2. Patient Characteristics1023_C Figure 3. Primary and secondary outcomes, propensity score matched