A C Murray1,2, S Markar2, H Mackenzie2, O Baser3, T Wiggins2, A Askari2, G Hanna2, O Faiz2, E Mayer2, C Bicknell2, A Darzi2, R P Kiran4,5. 1. Division of Colorectal Surgery, New York Presbyterian Hospital/Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor: 8, New York, NY, 10032, USA. 2. Department of Surgery and Cancer, Imperial College London, London, UK. 3. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA. 4. Division of Colorectal Surgery, New York Presbyterian Hospital/Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor: 8, New York, NY, 10032, USA. rpk2118@cumc.columbia.edu. 5. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA. rpk2118@cumc.columbia.edu.
Abstract
BACKGROUND: Evidence supports early laparoscopic cholecystectomy for acute cholecystitis. Differences in treatment patterns between the USA and UK, associated outcomes and resource utilization are not well understood. METHODS: In this retrospective, observational study using national administrative data, emergency patients admitted with acute cholecystitis were identified in England (Hospital Episode Statistics 1998-2012) and USA (National Inpatient Sample 1998-2011). Proportions of patients who underwent emergency cholecystectomy, utilization of laparoscopy and associated outcomes including length of stay (LOS) and complications were compared. The effect of delayed treatment on subsequent readmissions was evaluated for England. RESULTS: Patients with a diagnosis of acute cholecystitis totaled 1,191,331 in the USA vs. 288 907 in England. Emergency cholecystectomy was performed in 628,395 (52.7% USA) and 45,299 (15.7% England) over the time period. Laparoscopy was more common in the USA (82.8 vs. 37.9%; p < 0.001). Pre-treatment (1 vs. 2 days; p < 0.001) and total ( 4 vs. 7 days; p < 0.001) LOS was lower in the USA. Overall incidence of bile duct injury was higher in England than the USA (0.83 vs. 0.43%; p < 0.001), but was no different following laparoscopic surgery (0.1%). In England, 40.5% of patients without an immediate cholecystectomy were subsequently readmitted with cholecystitis. An additional 14.5% were admitted for other biliary complications, amounting to 2.7 readmissions per patient in the year following primary admission. CONCLUSION: This study highlights management practices for acute cholecystitis in the USA and England. Despite best evidence, index admission laparoscopic cholecystectomy is performed less in England, which significantly impacts subsequent healthcare utilization.
BACKGROUND: Evidence supports early laparoscopic cholecystectomy for acute cholecystitis. Differences in treatment patterns between the USA and UK, associated outcomes and resource utilization are not well understood. METHODS: In this retrospective, observational study using national administrative data, emergency patients admitted with acute cholecystitis were identified in England (Hospital Episode Statistics 1998-2012) and USA (National Inpatient Sample 1998-2011). Proportions of patients who underwent emergency cholecystectomy, utilization of laparoscopy and associated outcomes including length of stay (LOS) and complications were compared. The effect of delayed treatment on subsequent readmissions was evaluated for England. RESULTS:Patients with a diagnosis of acute cholecystitis totaled 1,191,331 in the USA vs. 288 907 in England. Emergency cholecystectomy was performed in 628,395 (52.7% USA) and 45,299 (15.7% England) over the time period. Laparoscopy was more common in the USA (82.8 vs. 37.9%; p < 0.001). Pre-treatment (1 vs. 2 days; p < 0.001) and total ( 4 vs. 7 days; p < 0.001) LOS was lower in the USA. Overall incidence of bile duct injury was higher in England than the USA (0.83 vs. 0.43%; p < 0.001), but was no different following laparoscopic surgery (0.1%). In England, 40.5% of patients without an immediate cholecystectomy were subsequently readmitted with cholecystitis. An additional 14.5% were admitted for other biliary complications, amounting to 2.7 readmissions per patient in the year following primary admission. CONCLUSION: This study highlights management practices for acute cholecystitis in the USA and England. Despite best evidence, index admission laparoscopic cholecystectomy is performed less in England, which significantly impacts subsequent healthcare utilization.
Entities:
Keywords:
Acute cholecystitis; Cholecystectomy; International comparisons; Laparoscopy; Quality
Authors: S F Khuri; J Daley; W Henderson; K Hur; M Hossain; D Soybel; K W Kizer; J B Aust; R H Bell; V Chong; J Demakis; P J Fabri; J O Gibbs; F Grover; K Hammermeister; G McDonald; E Passaro; L Phillips; F Scamman; J Spencer; J F Stremple Journal: Ann Surg Date: 1999-09 Impact factor: 12.969
Authors: Carsten N Gutt; Jens Encke; Jörg Köninger; Julian-Camill Harnoss; Kilian Weigand; Karl Kipfmüller; Oliver Schunter; Thorsten Götze; Markus T Golling; Markus Menges; Ernst Klar; Katharina Feilhauer; Wolfram G Zoller; Karsten Ridwelski; Sven Ackmann; Alexandra Baron; Michael R Schön; Helmut K Seitz; Dietmar Daniel; Wolfgang Stremmel; Markus W Büchler Journal: Ann Surg Date: 2013-09 Impact factor: 12.969
Authors: A J Sutton; R S Vohra; M Hollyman; P J Marriott; A Buja; D Alderson; S Pasquali; E A Griffiths Journal: Br J Surg Date: 2016-10-20 Impact factor: 6.939
Authors: Syed Nabeel Zafar; Augustine Obirieze; Babawande Adesibikan; Edward E Cornwell; Terrence M Fullum; Daniel D Tran Journal: JAMA Surg Date: 2015-02 Impact factor: 14.766
Authors: Saskia E Drösler; Niek S Klazinga; Patrick S Romano; Daniel J Tancredi; Maria A Gogorcena Aoiz; Moira C Hewitt; Sarah Scobie; Michael Soop; Eugene Wen; Hude Quan; William A Ghali; Soeren Mattke; Edward Kelley Journal: Int J Qual Health Care Date: 2009-04-24 Impact factor: 2.038
Authors: Ewen M Harrison; Stephen O'Neill; Thomas S Meurs; Pang L Wong; Mark Duxbury; Simon Paterson-Brown; Stephen J Wigmore; O James Garden Journal: BMJ Date: 2012-05-23
Authors: Mina M B Fouad; Samuel S S Rezk; Arsany T Saber; Ahmed Khalifa; Peter Ibraheim; Sandy M N Ibraheim Journal: Asian J Endosc Surg Date: 2021-09-01
Authors: Tom Wiggins; Sheraz R Markar; Hugh MacKenzie; Omar Faiz; Dipankar Mukherjee; David E Khoo; Sanjay Purkayastha; Ian Beckingham; George B Hanna Journal: Surg Endosc Date: 2019-04-04 Impact factor: 4.584
Authors: Michael A Glaysher; Peter May-Miller; Nicholas C Carter; Gijs van Boxel; Philip H Pucher; Benjamin C Knight; Stuart J Mercer Journal: Surg Endosc Date: 2022-09-13 Impact factor: 3.453
Authors: Tom Wiggins; Sheraz R Markar; Hugh Mackenzie; Sara Jamel; Alan Askari; Omar Faiz; Stavros Karamanakos; George B Hanna Journal: Surg Endosc Date: 2018-07-25 Impact factor: 4.584