Introduction: Choleperitonitis is defined as inflammation of the peritoneum caused by the escape of bile into the peritoneal cavity. This may be secondary to pathologic or iatrogenic rupture of the gallbladder and/or the biliary system. Limited epidemiological data exist on the number of hospitalizations, demographic variation, cost of care, comorbidity measures, and outcomes for Choleperitonitis.
Methods: We analyzed the National Inpatient Sample (NIS) database for all hospitalizations with Choleperitonitis (ICD-9 code 567.81 and ICD-10 code K65.3 as applicable) as primary or secondary diagnosis during the period from 2012-2018. NIS is the largest all-payer inpatient care database in the United States. Statistical significance of variation in the number of hospitalizations, demographic disparity, cost of care, comorbidity measures, and outcomes during the study period were determined using Cochran-Armitage trend test.
Results: Between 2012 and 2018, the number of hospitalizations for Choleperitonitis ranged from from 2,030 to 2,485 (p=0.04, figure 1A). Hospitalizations with Choleperitonitis were found to be more common in women (p=0.03) and Caucasians (p=0.001). Although age group 45-64 remained the most affected, there was an overall proportional decrease from 38.6% to 32.5% (p=0.0006, figure 1B). Generally, South remained the most affected region (p=0.03) throughout the study period. There was a significant rise in the West from 24.1% to 29.2% (p=0.0002) with a concurrent decrease in the South from 37.2% to 31.3% (p=0.03). A proportional decrease in the number of hospitalizations was seen at both, urban non-teaching (35.6% to 19.4%, p< 0.0001, figure 1C) and rural hospitals (9.9% to 6.5%, p< 0.0001, figure 1C), while the number increased at urban teaching hospitals (54.5% to 74.2%, p< 0.0001, figure 1C). Mean length of hospital stay for Choleperitonitis ranged from 12.3 ± 0.6 to 14.3 ± 0.9 days (p=0.07). Overall mortality ranged from 5.1% to 10.7% (p=0.05, figure 1D). Some of the most associated comorbid conditions with Choleperitonitis were fluid and electrolyte disorders, hypertension, weight loss, deficiency anemias, and obesity.
Discussion: During the study period, the annual number of hospitalizations with Choleperitonitis largely remained stable with interesting demographic variations and association with comorbidities. Further studies are needed to identify factors responsible for such trends to better elucidate our findings.
