S0069 Cholecystitis Associated With Extracorporeal Membrane Oxygenation: Temporal Trends and Outcomes From National Inpatient Sample Analysis From 2010-2017

Abstract

INTRODUCTION: Extracorporeal Membrane Oxygenation (ECMO) has become essential support to patients with severe cardiac and pulmonary dysfunction refractory to conventional management. The usage of ECMO has strikingly progressed, especially during the pandemic of novel coronavirus disease 2019. Previous research has shown increased frequencies of cholecystostomy and cholecystectomy in patients receiving ECMO. The aim of this study was to determine the trends and outcomes of cholecystitis in hospitalized patients receiving ECMO. METHODS: The NIS database was used to identify adult patients receiving ECMO who had the diagnosis of cholecystitis from 2010 to 2017 using ICD codes. Primary outcomes included the trend of prevalence of ECMO, cholecystitis, and inpatient outcomes. RESULTS: Between 2010 and 2017, there was an uptrend in the number of patients receiving ECMO (weighted: 1471 in 2010 to 8525 in 2017, P < 0.0001), while the rate of cholecystitis has remained stable (1.4%). In patients receiving ECMO with cholecystitis, 73.9% had acalculous cholecystitis (ACC). Both patients with ACC and calculous cholecystitis (CC) had high mortality rates (48.8% vs. 61.5%), prolonged length of stay (LOS) (38.9 vs. 46 days) and significant hospitalization charges ($1214147.4 vs. $1346440.9), with an uptrend in hospitalization charges (P < 0.0001). More than 95% of ECMO patients with cholecystitis had at least two Elixhauser comorbidities. ECMO patients with ACC were generally Caucasian (56.5%) and male (72.8%) dominant with an average age of 51.3 years old. More than 90% were treated in medium to large urban teaching hospitals, and more than 50% had private insurance. Compared to CC patients, patients with ACC were more likely to be male (P = 0.042) and had fewer cardiogenic indications for ECMO (P = 0.011). The ACC cohort was also associated with higher rates of HCV infection (P = 0.020) and cirrhosis (P = 0.007). CONCLUSION: This study demonstrated a stable rate of cholecystitis from 2010 to 2017 in ECMO patients despite an increased number of ECMO use. ECMO patients with cholecystitis were associated with more comorbidities, high mortality rates, prolonged LOS and significant hospitalization costs. Patients with ACC were associated with fewer cardiogenic indications for ECMO, but more HCV infection and cirrhosis compared to those with CC. Further prospective studies are needed to evaluate the different characteristics and underlying pathophysiology between ACC and CC in patients receiving ECMO.Table 1Table 2