Staten Island University Hospital, Northwell Health Staten Island, NY, United States
Harika Kandlakunta, MD1, Sri Harsha Patlolla, MBBS2, Sajan Nagpal, MD3 1Staten Island University Hospital, Northwell Health, Staten Island, NY; 2Mayo Clinic, Rochester, MN; 3University of Chicago, Chicago, IL
Introduction: Studies have shown a decreased incidence of recurrent complications if same admission cholecystectomy (SAC) is performed for patients with mild acute biliary pancreatitis (MBP). However, there continues to be a wide variation in practice between centers. Furthermore, whether there are disparities in SAC based on patient characteristics has not been studied.
Methods: Using the National Inpatient Sample database (January 2003-December 2017) we identified all adult hospitalizations with a primary diagnosis of acute pancreatitis (AP) and their etiology based on ICD-9 and 10 codes Patients with severe AP were then excluded to arrive at the MBP cohort. Rates of SAC and or in-hospital mortality (IHM) were evaluated. Adjusted outcomes were analyzed using a multivariable logistic regression model incorporating age, sex, race, socioeconomic status, hospital characteristics, primary payer, congestive heart failure, hypertension, diabetes, chronic lung and renal disease, liver disease and obesity.
Results: Between 2003 and 2017, there were 736,633 hospital admissions for MBP. Of these 360,128 (48.9%) underwent SAC. Adjusted trends revealed a slight increase in SAC over time (OR for 2017 vs 2003, 1.10 [95% CI 1.07-1.14]; P< 0.001). Compared to those undergoing SAC, MBP hospitalizations not undergoing SAC were older (59.5±19.6 vs 53.1±19.4, P< 0.001) and had higher comorbidity index scores. Unadjusted and adjusted comparisons showed that females (50.8% vs 45.5%; OR 1.11 [95% CI 1.10-1.12]; P< 0.001) and those admitted to teaching hospitals (49.3% vs 48.6%; OR 1.06 [95% CI 1.05-1.08]; P< 0.001) were more likely to undergo SAC. In comparison to White patients, Black patients (46.4% vs 47.0%; 0.87 [95% CI 0.85-0.88]; P< 0.001) were less likely, whereas ‘Other’ race patients (55.3% vs 47.0%; 1.16 [95% CI 1.14-1.18]; P< 0.001) were more likely to undergo SAC. Patients that underwent SAC had lower adjusted IHM (0.1% vs 0.4%, OR 0.31 [95% CI 0.26-0.36]; P< 0.001). Among those with SAC, IHM was similar between women and men. Compared to White patients undergoing SAC, IHM was significantly higher among Black patients (3.32 [95% CI 2.10-5.23]; P< 0.001) but similar to ‘other’ race admissions (OR 1.06 [95% CI 0.64-1.74]; P=0.83).
Discussion: While rates of SAC for MBP appear to be slowly increasing over the last two decades, reasons for persistent disparities in rates of SAC based on race should be explored especially given the lower likelihood of SAC and higher IHM in Black patients.
Figure: Trends in proportions of acute pancreatitis etiology
Harika Kandlakunta indicated no relevant financial relationships.
Sri Harsha Patlolla indicated no relevant financial relationships.
Sajan Nagpal indicated no relevant financial relationships.
Harika Kandlakunta, MD1, Sri Harsha Patlolla, MBBS2, Sajan Nagpal, MD3. P0026 - Disparities in Rate and Predictors of Same Admission Cholecystectomy and Mortality in Patients With Mild Acute Biliary Pancreatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.