MedStar Georgetown University Hospital Washington, District of Columbia
Albert C. Shu, MD1, Cory Higley, DO, MPH1, Rabin Neupane, MBBS2, Disha Sharma, MBBS2, Wei Yan, MD1, Andrew Stevens, MD1, Bryan S. Stone, DO1, Shandiz Shahbazi, MD1, Ilan Vavilin, MD1, Nadim G. Haddad, MD3, Sandeep Nadella, MBBS1; 1MedStar Georgetown University Hospital, Washington, DC; 2MedStar Washington Hospital Center, Washington, DC; 3MedStar Georgetown University Hospital, Potomac, MD
Introduction: Cholecystectomy performed during an admission for gallstone pancreatitis (GP) has been reported to reduce both length of stay (LOS) and future encounters without causing an increase in complications. Despite this, rates of cholecystectomy remain low. To understand real-world trends of patients who underwent cholecystectomy after diagnosis of GP, we characterized their rates, risks, benefits, comorbid conditions, location of care and contrasted them across a nine-hospital system. Methods: ICD-10 codes were used to retrieve charts of patients presenting to the MedStar Health between March 2015-June 2019. These included emergency department visits and inpatient admissions. Charts meeting Revised Atlanta Classification for acute pancreatitis (AP) were reviewed. Charts that carried a diagnosis of GP were put into two groups, 1) those that underwent same-admission cholecystectomy (SAC) and 2) those who did not. These groups were then compared for the following variables: LOS, future encounter and complication rates, location of care, history of cholelithiasis or choledocholithiasis and presence of hypertension, coronary artery disease, congestive heart failure, asthma/chronic obstructive pulmonary disease, smoking status, chronic kidney disease or cirrhosis. Statistical analysis was performed using GraphPad PRISM. Results: 1722 of 2541 charts met criteria for AP; 366 of which carried a diagnosis of GP. LOS was observed to be greater in those who underwent SAC when compared to those who did not (5.5 vs 4.2 days, 95% Cl 0.26–2.26, P = .0138.) Patients at tertiary centers were observed to have been less likely to undergo SAC (31.4% vs 44.5%, OR 0.570, P=.0151.) There was no significant difference in rates of future encounters or complications, presence of comorbidities or history of either cholelithiasis (50.0% vs 48.4%, P=.831) or choledocholithiasis (7.64% vs 8.60%, P=.847) between the two groups. Discussion: In patients with GP, SAC was associated with increased LOS. Despite the association between choledocholithiasis or cholelithiasis and GP, there was no correlation between SAC and history of these prior conditions. This lower rate of SAC at tertiary centers could reflect a lack of penetrance of guideline adherence. Given these findings, the balance between benefit and risk remains to be one that warrants careful consideration and further investigation.
Figure 1. Length of stay compared between same-admission cholecystectomy and no cholecystectomy groups.
Figure 2. Prevalence of cholelithiasis history in same-admission cholecystectomy and no cholecystectomy groups.
Figure 3. Prevalence of choledocholithiasis history in same-admission cholecystectomy and no cholecystectomy groups.
Disclosures: Albert Shu indicated no relevant financial relationships. Cory Higley indicated no relevant financial relationships. Rabin Neupane indicated no relevant financial relationships. Disha Sharma indicated no relevant financial relationships. Wei Yan indicated no relevant financial relationships. Andrew Stevens indicated no relevant financial relationships. Bryan Stone indicated no relevant financial relationships. Shandiz Shahbazi indicated no relevant financial relationships. Ilan Vavilin indicated no relevant financial relationships. Nadim Haddad indicated no relevant financial relationships. Sandeep Nadella indicated no relevant financial relationships.