P1084 - Same Admission Cholecystectomy for Patients Admitted With Acute Gallstone Pancreatitis: Testing a Hospital-Based Quality Metric

Neesha Nama, MD¹, Aaron M. Hein, MD¹, Sandra Au, BS², Jared N. Gloria, MD³, Courtney M. Richman, MD¹, Alice Parish, MSPH⁴, Donna Niedzwiecki, PhD², Alyson McGhan Johnson, MD¹, Joshua P. Spaete, MD¹, Darshan J. Kothari, MD^1
1Duke University Medical Center, Durham, NC; ²Duke University School of Medicine, Durham, NC; ³Emory University Hospital, Atlanta, GA; ⁴Duke University, Durham, NC

Introduction: Gallstones are a leading cause of acute pancreatitis (AP) in the United States. Professional societies delineate evidence-based guidelines for management of gallstone-mediated AP in an effort to reduce gallstone related complications. One such guideline is cholecystectomy (CCY) during index admission for gallstone pancreatitis. Our study aims to assess rates of adherence to this hospital-based quality metric and identify predictors to non-adherence.

Methods: We performed a retrospective review of patients admitted with AP to a large multihospital health system between October 2019 and October 2020. Adult patients meeting revised Atlanta criteria (RAC) for AP were included. Gallstone AP was defined by evidence of cholelithiasis on imaging or cholestatic pattern of liver injury in the absence of another cause. Exclusion criteria included not meeting RAC, patients < 18 years old, concurrent diagnosis of pancreatic cancer, history of pancreatic surgery, admission for AP within 30 days, or history of CCY. Severity categorization also followed RAC. Our primary outcome was percentage of patients undergoing CCY during the same hospitalization for gallstone AP. Secondary outcomes included length of stay (LOS) and rates of readmission within 30 days of discharge.

Results: During our study period, 309 patients met inclusion criteria. 114 patients met criteria for gallstone AP and of these 10 patients were excluded due to a prior CCY. Of the remaining 104 patients, 32.7% of patients did not undergo CCY during the same admission. A greater proportion of patients who did not undergo CCY were male, non-white, and were admitted to the community hospital (p >0.05). LOS was not different between the groups however 30 day readmission was significantly higher in patients without CCY (32% vs 9%, p< 0.01). Of those who did not undergo CCY, 74% received a surgical consult during the hospitalization. An analysis of reasons given to defer CCY showed no prevailing theme.

Discussion: In our cohort, we found that nearly one-third of patients did not undergo CCY and these patients had a higher rate of readmission within 30 days. Importantly patients undergoing CCY did not have a longer LOS suggesting that CCY during index hospitalization does not increase healthcare burden. Further data is needed to understand the barriers to CCY during index hospitalization and to better characterize practice patterns. Further quality improvement interventions will focus on these areas.

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