Cutting out Cholecystectomy on Index Hospitalization Leads to Increased Readmission Rates, Morbidity, Mortality and Cost

Gangu, Karthik; Bobba, Aniesh; Chela, Harleen K.; Başar, Ömer; Min, Robert Win Maw; Tahan, Veysel; Daglilar, Ebubekir

doi:10.3390/diseases9040089

Cited by 5 publications

(6 citation statements)

References 26 publications

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“…Analysis of index hospitalizations' outcomes showed that the cholecystectomy group had the lowest mortality rates among the four groups. Previous studies showed that cholecystectomy was associated with decreased mortality in patients with BAP [10,54]. Both procedures group had also a comparable low mortality rate, and this was consistent with the available evidence of no additional mortality benefit when ERCP was performed along with cholecystectomy as discussed above.…”

Section: Discussionsupporting

confidence: 86%

Readmissions After Biliary Acute Pancreatitis: Analysis of the Nationwide Readmissions Database

et al. 2022

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Background: Acute pancreatitis is a common inflammatory condition that involves the pancreas. Gallstones and alcohol are the most common etiologies in the USA. Cholecystectomy is the cornerstone procedure in the management of biliary acute pancreatitis (BAP). In this study, we examined the causes and predictors of readmissions following BAP based on the procedure performed.Methods: Using the Nationwide Readmissions Database (NRD) and the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD10-CM/PCS), we retrospectively studied BAP hospitalizations (2016 -2018). The first hospitalization within the year was marked as index hospitalization. Index hospitalizations were categorized based on whether an endoscopic retrograde cholangiopancreatography (ERCP) and/or a cholecystectomy was performed into no procedure group, ERCP group, cholecystectomy group, and both procedures group. We subsequently identified readmissions within 30 days. Using this categorization, we studied reasons, rates, and predictors of readmissions.Results: A total of 127,318 index hospitalizations were included. The cholecystectomy group constituted the largest share of this cohort (43.5%). Using the no procedure group as a reference, analysis of the outcomes showed that the cholecystectomy group had the lowest inpatient mortality (adjusted odds ratio (aOR): 0.18, P < 0.001), while both procedures group had the highest total hospital charges (adjusted mean difference (aMD): 42,249, P < 0.001). Acute pancreatitis without necrosis or infection was the most frequent principal diagnosis for readmission (18.7%). Analysis of readmission predictors showed that both procedures group had the lowest risk for readmission (adjusted hazard ratio (aHR): 0.40, P < 0.001). Females were less likely to be readmitted compared to males (aHR: 0.82, P < 0.001) and elderly were less likely to be readmitted compared to young adults (aHR: 0.82, P < 0.001). Patients discharged against medical advice were more likely to be readmitted (aHR: 1.76, P < 0.001). Conclusion:Undergoing both ERCP and cholecystectomy for BAP resulted in significantly higher hospital charges with no additional mortality benefit. However, it decreased the readmission risk significantly. Acute pancreatitis without necrosis or infection was the most frequent reason for readmissions.

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Section: Discussionsupporting

confidence: 86%

Readmissions After Biliary Acute Pancreatitis: Analysis of the Nationwide Readmissions Database

et al. 2022

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“…Despite current recommendations, pediatric index cholecystectomy was only performed in 59% of admissions for biliary acute pancreatitis and choledocholithiasis. Interestingly, this trend is mirrored in multiple analogous retrospective studies in the adult literature, even after the foundational randomized controlled PONCHO trial, which showed that compared with delayed cholecystectomy, index admission cholecystectomy reduced rate of recurrent gallstone-related complications in patients with mild BAP [ 6 – 8 , 18 ]. These findings were momentous in adult literature and emphasized the needless hospital readmission and healthcare utilization brought on by delayed cholecystectomy.…”

Section: Discussionmentioning

confidence: 96%

“…The benefits of early cholecystectomy for biliary acute pancreatitis (BAP) and choledocholithiasis have been well established and include lower readmission, lower hospital length of stay, and less biliary-related complications [ 6 – 8 ]. However, recommendations for management of pediatric gallstone disease is largely based on small population studies, single center studies, or expert opinion [ 9 – 11 ].…”

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confidence: 99%

Index admission cholecystectomy for biliary acute pancreatitis or choledocholithiasis reduces 30-day readmission rates in children

Pathak,

Avila,

Dai

et al. 2024

Surg Endosc

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Background Adult patients with biliary acute pancreatitis (BAP) or choledocholithiasis who do not undergo cholecystectomy on index admission have worse outcomes. Given the paucity of data on the impact of cholecystectomy during index hospitalization in children, we examined readmission rates among pediatric patients with BAP or choledocholithiasis who underwent index cholecystectomy versus those who did not. Methods Retrospective study of children (< 18 years old) admitted with BAP, without infection or necrosis (ICD-10 K85.10), or choledocholithiasis (K80.3x–K80.7x) using the 2018 National Readmission Database (NRD). Exclusion criteria were necrotizing pancreatitis with or without infected necrosis and death during index admission. Multivariable logistic regression was performed to identify factors associated with 30-day readmission. Results In 2018, 1122 children were admitted for index BAP (n = 377, 33.6%) or choledocholithiasis (n = 745, 66.4%). Mean age at admission was 13 (SD 4.2) years; most patients were female (n = 792, 70.6%). Index cholecystectomy was performed in 663 (59.1%) of cases. Thirty-day readmission rate was 10.9% in patients who underwent cholecystectomy during that index admission and 48.8% in those who did not (p < 0.001). In multivariable analysis, patients who underwent index cholecystectomy had lower odds of 30-day readmission than those who did not (OR 0.16, 95% CI 0.11–0.24, p < 0.001). Conclusions Index cholecystectomy was performed in only 59% of pediatric patients admitted with BAP or choledocholithiasis but was associated with 84% decreased odds of readmission within 30 days. Current guidelines should be updated to reflect these findings, and future studies should evaluate barriers to index cholecystectomy.

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“…Children most at risk for acute cholecystitis are those with comorbid conditions that would increase their propensity to form gallstones such as hemolytic disorders, obesity, congenital malformations, parenteral nutrition, cystic fibrosis, and short bowel syndrome [ 1 , 4 ]. Early cholecystectomy in adult patients with acute cholecystitis has been widely studied and shown to be safe with less morbidity, shorter hospital stays, and lower readmission rates than those who underwent delayed cholecystectomy [ 5 – 9 ]. In contrast, ideal surgical timing and management of the pediatric population has been less studied, which has led to heterogenous management practices [ 10 ].…”

mentioning

confidence: 99%

Index admission cholecystectomy for acute cholecystitis reduces 30-day readmission rates in pediatric patients

Pathak,

Ji,

Nijagal

et al. 2023

Surg Endosc

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Background Adult patients with cholecystitis who do not undergo cholecystectomy on index admission have worse outcomes, however, there is a paucity of data of the role of cholecystectomy during index hospitalization in the pediatric population. Our aim was to determine outcomes and readmission rates among pediatric patients with cholecystitis who underwent index cholecystectomy versus those who did not. Methods We performed a retrospective study of pediatric (< 18 years old) admitted with acute cholecystitis (AC) requiring hospitalization using the 2018 National Readmission Database (NRD). Exclusion criteria included age ≥ 18 years and death on index admission. Multivariable logistic regression was performed to identify factors associated with 30-day readmissions. Results We identified 550 unique index acute cholecystitis admissions. Mean age was 14.6 ± 3.0 years. Majority of patients were female (n = 372, 67.6%). Index cholecystectomy was performed in (n = 435, 79.1%) of cases. Thirty-day readmission rate was 2.8% in patients who underwent index cholecystectomy and 22.6% in those who did not (p < 0.001). On multivariable analysis, patients who did not undergo index cholecystectomy had higher odds of 30-day readmission than those who did not (OR 10.66, 95% CI 5.06–22.45, p < 0.001). Female patients also had higher odds of 30-day readmission compared to males (OR 3.37, 95% CI 1.31–8.69). Conclusions Patients who did not undergo index cholecystectomy had over tenfold increase in odds of 30-day readmission. Further research is required to understand the barriers to index cholecystectomy despite society recommendations and clear clinical benefit.

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Cutting out Cholecystectomy on Index Hospitalization Leads to Increased Readmission Rates, Morbidity, Mortality and Cost

Cited by 5 publications

References 26 publications

Readmissions After Biliary Acute Pancreatitis: Analysis of the Nationwide Readmissions Database

Readmissions After Biliary Acute Pancreatitis: Analysis of the Nationwide Readmissions Database

Index admission cholecystectomy for biliary acute pancreatitis or choledocholithiasis reduces 30-day readmission rates in children

Index admission cholecystectomy for acute cholecystitis reduces 30-day readmission rates in pediatric patients

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