Predictors of same-admission cholecystectomy in mild, acute, biliary pancreatitis.

Abstract

Failure to perform same-admission cholecystectomy (SA-CCY) for mild, acute, biliary pancreatitis (MABP) is a recognized risk factor for recurrence and readmission. However, rates of SA-CCY are low and factors associated with these low rates require elucidation. Primary MAPB admissions were pooled from NIS 2000-2014 (weighted n=578258). Patients with chronic pancreatitis, pancreatic masses, alcohol-related disorders, hypertriglyceridemia, acute cholecystitis and AP-related organ dysfunction or complications were excluded. Annual rates of SA-CCY were calculated. Regression model for prediction of SA-CCY was built on 2010-2011 subset (weighted n=74169), yielding 96.3% of complete observations. Nationwide rate of SA-CCY in the U.S. was 40.8%. In multivariate analysis, SA-CCY was positively associated with BMI>30 (OR=1.4, 95%CI 1.2-1.6), Asian ethnicity (vs. Black; OR=1.2, 95%CI 1.0-1.5), private insurance (vs. Medicare; OR=1.1, 95%CI 1.0-1.3), large (vs. small; OR=1.3, 95%CI 1.2-1.4) urban hospitals (vs. rural; OR=1.5 95%CI 1.3-1.7) of the South (vs. Northeast; OR=1.5, 95%CI 1.3-1.7), as well as with chronic cholecystitis (OR=17.0, 95%CI 15.4-18.7) and abdominal-wall hernias (OR=5.2; 95%CI 3.0-8.9); the latter two predictors were not included in the final model. SA-CCY was negatively associated with age >40 (OR=0.72; 95%CI 0.66-0.79), male gender (OR=0.86, 95%CI 0.80-0.93), dementia (OR=0.88, 95%CI 0.72-1.1), chronic comorbidities (OR=0.64; 95%CI 0.54-0.77) and ostomies (OR=0.51; 95%CI 0.31-0.86). Adherence to SA-CCY guidelines for MABP remains inadequate. Independent geographic variation in SA-CCY rates may be related to reimbursement differences, ownership of AP patients, accessibility to surgical care, or cultural characteristics of the patient population.