Nationwide trends of hospital admissions for acute cholecystitis in the United States

Abstract

Background and aims: Acute cholecystitis is a fairly common inpatient diagnosis among the gastrointestinal disorders. The aim of this study was to use a national database of US hospitals to evaluate the incidence and costs of hospital admissions associated with acute cholecystitis.Method: We analyzed the National Inpatient Sample Database (NIS) for all patients in which acute cholecystitis (ICD-9 codes: 574.00, 574.01, 574.30, 574.31, 574.60, 574.61 or 575.0) was the principal discharge diagnosis from 1997 to 2012. The NIS is the largest all-payer inpatient database in the United States and contains data from approximately 8 million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, lengths of stay and associated hospital costs over the study period was determined by using the Chi-square test for trends.Results: In 1997, there were 149 661 hospital admissions with a principal discharge diagnosis of acute cholecystitis, which increased to 215 995 in 2012 ( P < 0.001). The mean length of stay for acute cholecystitis decreased by 17% between 1997 and 2012 (i.e. from 4.7 days to 3.9 days; (P < 0.05). During the same time period, however, mean hospital charges have increased by 195.4 % from US$14 608 per patient in 1997 to US$43 152 per patient in 2012 ( P < 0.001).Conclusion: The number of inpatient discharges related to acute cholecystitis has increased significantly in the United States over the last 16 years, along with a great increase in the associated hospital charges. However, there has been a gradual decline in the mean length of stay. Inpatient costs associated with acute cholecystitis contribute significantly to the total healthcare bill. Further research on cost-effective evaluation and management of acute cholecystitis is required.

Descriptive review of acute cholecystitis: Japan‐Taiwan collaborative epidemiological study

“…Previous epidemiological studies of AC include an epidemiological study in the United States using the national database for 1997 to 2012, which investigated factors including patients' age groups, sex, duration of hospitalization, treatment cost, and yearly rate of increase in patient numbers using data for a total of 149,661 patients discharged from hospitals in 1997 and 215,995 discharged in 2012 [22]. The results of that United States study differed from ours in that there were more female patients than male and the largest number of patients were aged 18-44.…”

“…In our study, we collected a large volume of clinical data covering factors including symptoms and signs, blood test results, diagnostic imaging findings, and treatment methods, enabling us to investigate matters such as the application of the TG13 diagnostic criteria and severity grading criteria for AC and what sort of treatment was actually provided, in addition to the significant United States report [22]. For example, we investigated the Charlson comorbidity index in detail.…”

Impact of medical or surgical admission on outcomes of patients with acute cholecystitis

“…3 Although laparoscopic surgery has significantly lowered hospital expenditures, the financial burden on the healthcare system secondary to AC remarkably increased in the last 3 decades. 15 It is estimated that the average total charges per patient increased by 195% and hospital costs associated with AC more than doubled in this time period. 15 Currently, surgeons and third-party payers are implementing more strict regulations to limit healthcare expenditures.…”

Right Upper Quadrant Pain: Ultrasound First!

“…Between 1997 and 2012, the number of patients discharged with a primary diagnosis of acute cholecystitis increased by 44.3%. It is estimated that over 700,000 cholecystectomies are performed annually in the United States . Ultrasound is the test of choice for the diagnosis of gallstones and cholecystitis.…”

“…It is estimated that over 700,000 cholecystectomies are performed annually in the United States. 2 Ultrasound is the test of choice for the diagnosis of gallstones and cholecystitis. It is a noninvasive, cost-effective technique that does not involve radiation exposure or iodinated contrast administration.…”