Artem Shmelev1, Anna Axentiev2, Mian B Hossain3, Steven C Cunningham2. 1. Department of Surgery, Saint Agnes Healthcare, Baltimore, MD, USA. Electronic address: Artem.Shmelev@ascension.org. 2. Department of Surgery, Saint Agnes Healthcare, Baltimore, MD, USA. 3. School of Community Health and Policy, Morgan State University, Baltimore, MD, USA.
Abstract
BACKGROUND: 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. METHODS: Primary MAPB admissions were pooled from NIS 2000-2014 (weighted n = 578 258). 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 = 74 169), yielding 96.3% of complete observations. RESULTS: 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). CONCLUSION: 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.
BACKGROUND: 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. METHODS: Primary MAPB admissions were pooled from NIS 2000-2014 (weighted n = 578 258). 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 = 74 169), yielding 96.3% of complete observations. RESULTS: 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). CONCLUSION: 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.