Regional Differences in Hospitalizations and Cholecystectomies for Biliary Dyskinesia

Abstract

Background/AimsPublished studies suggest that socioeconomic factors contribute to increasing cholecystectomy rates for biliary dyskinesia (BD). The aim of this study was to identify factors driving admissions and operations for BD by examining regional variability in hospitalizations and cholecystectomies for this disorder.MethodsAnnual hospitalizations and cholecystectomy rates for biliary diseases were assessed using the State Inpatient Databases of the Agency for Healthcare Research and Quality based on diagnosis codes for biliary dyskinesia, cholecystolithiasis and cholecystitis.ResultsAnnual admissions for BD varied nearly sevenfold among different states within the United States. Hospitalizations for gallstone disease and its complication showed less variability, differing 2-fold between states. Nearly 70% of admissions for BD and about 85% of admissions for gallstone disease resulted in cholecystectomies. Higher admission rates for BD were best predicted by high overall hospitalization rates, admission rate for gallstone disease and the physician workforce within a state. Cholecystectomy rates for BD were higher in states with low population density and high rates of cholecystectomy for gallstone disease.ConclusionsThese data suggest that established medical practice patterns significantly contribute to the variability in admissions and operations for biliary dyskinesia. The findings also indicate that lower thresholds for operative interventions are an important determinant in the approach to this disorder. Considering the benign course of functional illnesses, the bar for surgical interventions should be raised rather than lowered; in addition active conservative treatment options should be developed for these patients.

Gallbladder Dyskinesia

“…Similarly, an increased rate in GBD over time also was detected in the Mayo Clinic clinical data, although growing at a slower rate than previously described 12 . Marked regional variations appear to exist in the diagnosis of GBD, with a higher proportion of patients in the central and southern states 13 . In a cross-sectional survey of adults with functional gastrointestinal disorders only 0.2% met the Rome IV criteria for functional GB pain 14 .…”

“…12 Marked regional variations appear to exist in the diagnosis of GBD, with a higher proportion of patients in the central and southern states. 13 In a cross-sectional survey of adults with functional gastrointestinal disorders only 0.2% met the Rome IV criteria for functional GB pain. 14 Interestingly, the diagnosis of GBD is much lower in other countries.…”

Is functional gallbladder disease truly increasing? Results from the Rochester Epidemiology Project

“…The incidence of FGBD in Olmsted County (1.8/10.000) was much lower than the previously published incidence in administrative data for Minnesota (30/10,000). 11 Only a small fraction of patients (11%) with the ICD-9 code 575.8 for unspecified gallbladder diagnosis had FGBD compared to the State Inpatient Sample which reported that FGBD accounted for more than 80% of administrative code 575.8. It is unclear if that is a single studies overestimation/practice pattern that has informed a number of large scale data reviews or if this difference is specific to the Rochester Epidemiology Project.…”

“…7 In the absence of any truly definitive studies, there has been a growing discrepancy between expert consensus and the common practice of cholecystectomy in the absence of stone disease with several authors calling for RCTs. 8–11…”