Does acute cholangitis impact outcomes of cholangiocarcinoma? Insights from a nationwide database.

Abstract

e16138 Background: Cholangiocarcinoma is a malignancy associated with poor survival and outcomes. Structural abnormalities causing bile duct obstruction frequently lead to superimposed acute cholangitis (AC). We evaluated the impact of AC on hospitalized patients with cholangiocarcinoma. Methods: We investigated National Inpatient Sample 2019, employing International Classification of Diseases-10 (ICD-10) codes to include adult patients with cholangiocarcinoma. Analyses were performed using STATA (v 14.2), considering 2 sided P< 0.05 as statistically significant. Proportions were compared using Fisher exact test and continuous variables using Student’s t-test. Confounding variables were adjusted using multivariate logistic and linear regression analyses and included: gender, race, Charlson Comorbidity Index (CCI) score, median household income for patients’ zip codes, hospital location/region/ bedside, and insurance status. Results: A total of 36,900 patients were included in the analysis. Of those 15.26% (5,630) had AC on presentation (Table). Concomitant AC was associated with a higher adjusted length of stay (LOS) by 1.78 days and hospitalization cost by 3,028 USD in cholangiocarcinoma patients ( P< 0.01). There were higher adjusted odds of acute renal failure (Adjusted odds ratio (aOR) 1.31, P< 0.01) and lower odds of aspiration pneumonia while hospitalized in AC patients (aOR 0.37, P< 0.01). ERCP represented the primary technique of biliary drainage. No disparities were seen between the two groups undergoing ERCP or cholecystostomy tube, which resulted in comparable mortality trends ( P> 0.05). Rates of acute respiratory failure, mechanical ventilation, ICU admission, cardiac arrest, and sepsis were not different between the two groups ( P> 0.05). Conclusions: Unbiased and comparable biliary drainage via either ERCP or cholecystostomy resulted in observing no mortality differences between the two groups. However, superimposed AC in cholangiocarcinoma patients results in higher LOS driven by acute renal failure.[Table: see text]