Same-admission cholecystectomy halves gallstone pancreatitis rehospitalization
LAS VEGAS — Patients hospitalized for gallstone-associated acute pancreatitis were less likely to be readmitted within 30 days if they underwent same-admission cholecystectomy, according to a nationwide retrospective analysis presented at ACG 2016.
“Gallstone disease represents one of the two most common causes for acute pancreatitis,” Somashekar G. Krishna, MD, MPH, from the Ohio State University Wexner Medical Center, said during his presentation. “The current guidelines by the three major societies recommend same-admission cholecystectomy for non-necrotizing gallstone pancreatitis. However, several studies have shown that cholecystectomy is often delayed up to 6 weeks after discharge, [and] all-cause acute pancreatitis has a 30-day readmission rate of 17% to 21%.”
Somashekar G. Krishna
Because these data are from smaller studies, Krishna and colleagues aimed to assess national level data on 30-day readmission rates after gallstone-associated acute pancreatitis and factors associated with readmission rates.
Using the Healthcare Cost and Utilization Project’s Nationwide Readmission Database, they identified 41,094 adults with a primary discharge diagnosis of acute pancreatitis and a secondary diagnosis of gallstone related disorders in 2013.
Overall, 10.5% were rehospitalized within 30 days (median, 9 days), with acute pancreatitis-related diagnosis as the primary diagnosis for readmission in 30%, and the secondary diagnosis for readmission in 21%, including recurrent acute pancreatitis, chronic pancreatitis or pseudocyst.
Moreover, 59.5% underwent cholecystectomy during their index admission.
“The 30-day readmission rate was 6.5% in those who underwent cholecystectomy whereas it was more than double in those who did not get a cholecystectomy, at 15.1%,” Krishna said.
Index admission cholecystectomy was independently associated with reduced likelihood of 30-day readmission (OR = 0.43; 95% CI, 0.38-0.49).
Multivariate analysis also showed factors associated with a higher risk for 30-day readmission after index gallstone-associated acute pancreatitis included type of insurance, number of comorbidities, severe acute pancreatitis, increased length of stay and non-routine patient discharges.
In addition, multivariate analysis showed factors associated with having a same-admission cholecystectomy included female sex and having same-admission ERCP, while factors associated with not having a same-admission cholecystectomy included admission to small or rural hospitals, higher number of comorbidities, severe acute pancreatitis, sepsis and non-routine discharges.
“The results support adherence to major society guidelines,” Krishna said. “Nearly one in 10 patents with gallstone pancreatitis are readmitted within 30 days, so all patients with gallstone pancreatitis should be at least evaluated for same admission cholecystectomy, [and] patients admitted to small or rural hospitals should be considered for transfer to a tertiary care center for same-admission cholecystectomy.” – by Adam Leitenberger
Krishna SG, et al. Abstract #3. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 17-19, 2016; Las Vegas, NV.
Disclosures: The researchers report no relevant financial disclosures.