Tu1419 SAME HOSPITALIZATION CHOLECYSTECTOMY FOR ACUTE GALLSTONE PANCREATITIS: A NATIONWIDE ANALYSIS ACROSS A DECADE

Abstract

Gallstones are the leading cause of acute pancreatitis in developed countries. The International Association of Pancreatology and American Pancreatic Association recommend a cholecystectomy or at least a biliary sphincterotomy during the index hospitalization for acute gallstone pancreatitis (AGP). Prior data has shown that adherence to this recommendation is low. We aimed to delineate the national trends for same hospitalization cholecystectomy (SHC) for AGP over the last ten years. This was a retrospective cohort study using the 2004, 2009 and 2014 national inpatient sample, the largest nationally representative inpatient database in the United States. Inclusion criteria were a principal diagnosis of acute pancreatitis and a secondary diagnosis of choledocholithiasis or cholelithiasis. Exclusion criteria were age < 18 years and elective admission. The primary outcome was SHC trend over time. Secondary outcomes were: i) trends of inpatient endoscopic retrograde cholangiopancreatography (ERCP), ii) In-hospital mortality, length of stay (LOS) and total hospitalization costs and charges associated with SHC. A subgroup analysis was performed for teaching and non-teaching hospitals separately. All costs and charges were adjusted for inflation using the consumer price index. The yearly incidence was calculated using the corresponding July 1 Census estimate of the US population. Confounders (listed in Table 1) were accounted for using multivariable regression analysis. The results are summarized in Table 1 and Table 2. The incidence and number of admissions for AGP as well as the proportion of AGP among all acute pancreatitis were stable over the past decade. However, SHC (2004: 48.7%, 2009: 46.9%, 2014: 45%) and ERCP rates slowly declined over the same time period. Among patients who had a SHC, the mortality rate and LOS decreased, whereas total hospitalization charges and costs significantly increased from 2004 to 2014. After adjusting for confounders, the rate of in-hospital ERCP was higher in teaching compared with non-teaching hospitals, but both groups had similar SHC rate and mortality rate after cholecystectomy. In addition, teaching hospitals had longer LOS and higher total hospitalizations costs and charges compared with non-teaching hospitals. Adherence to the guidelines for in-hospital cholecystectomies and ERCP for patients admitted with AGP have been declining over the past decade. This decline is associated with, and therefore possibly motivated by, a significant decrease in-hospital mortality and resource utilization. Compared with non-teaching hospitals, teaching hospitals had higher adherence to the guidelines for inpatient ERCP. Despite the apparent financial reward, concerted efforts are needed to avoid interval cholecystectomy, which has been linked to recurrence of AGP and readmissions.View Large Image Figure ViewerDownload Hi-res image Download (PPT)