USE OF CHOLECYSTECTOMY DECREASING IN PATIENTS WITH CROHN'S DISEASE
Paul T. Kroner*, Alex M. Kesler, Peter Abader, Mohammad Afsh, Bhaumik Brahmbhatt, John R. Cangemi
Mayo Clinic Florida, Jacksonville, FL
Introduction
Crohn's disease (CD) is associated with an increased risk of gallstone formation, likely related to bile salt depletion secondary to terminal ileal disease or resection, which theoretically leads to higher rates of calculous cholecystitis. The management of CD has changed markedly in the past decade with increased utilization of biologics. Past studies suggest increasing rates of hospital complications, prolonged stay, and higher charges, in CD. However, these studies were relatively small, old, and examined limited number of outcomes. Thus, the aim of our study was to examine the temporal trends in hospital admissions for patients with CD, cholecystectomy (CCY) use in patients with as well as resource utilization.
Methods
Case-control study using the NIS 2007, 2010, 2013 and 2016, the largest public inpatient database in the US. All patients with ICD9-10CM codes for CD were included. None were excluded. The primary outcome was determining the temporal trends in the use of CCY in patients with CD across the past decade. Secondary outcomes were determining the number of patient admissions with CD, trend in additional inflation-adjusted hospital costs, charge and length of hospital stay (LOS) in patients undergoing CCY in the past decade. Multivariate regression analyses were used to adjust for gender, age, Charlson Comorbidity Index, income in patient zip code, hospital region, location, size and teaching status.
Results
A total number of 759,609 patients with CD were included in the study, of which 1.0% underwent CCY. The mean age was 52 years, and 60% were female. For the primary outcome, the odds of patients with CD undergoing CCY was 0.76 (p<0.01) in 2016 compared to 2007. For the secondary outcomes, the total number of patients that were admitted and had an associated diagnosis of CD increased from 157,836 in 2007 to 209,190 in 2017, which was confirmed after adjusting for confounders (OR:1.58, p<0.01). There was no significant change in hospital costs, while adjusted mean hospital charges increased $21,918 (p<0.01), and LOS decreased (-1.09 days, p=0.04) in 2016 compared to 2007. All outcomes are depicted in Table 1.
Conclusion
Although the total number of hospitalizations for patients with Crohn's disease are increasing, the odds of undergoing cholecystectomy decreasing. It is speculated that better disease control in the era of widespread biologic use may also have decreased gallbladder disease by restoring the enterohepatic circulation in patients with terminal ileal disease. Increased hospital admissions could potentially reflect progression of disease or complications of immunosuppression secondary to biologics, including increased risk of infection. Further studies are needed to verify and better characterize the reasons behind this observed decrease in cholecystectomy use in patients with Crohn's disease.
Table 1
| aOR (95% CI), p-value | |||
| Variable | 2010 | 2013 | 2016 |
| CD | 1.31 (1.24-1.39), <0.01 | 1.45 (1.38-1.52), <0.01 | 1.58 (1.50-1.66), <0.01 |
| Overall Cholecystectomy | 0.82 (0.71-0.95), <0.01 | 0.70(0.61-0.82), <0.01 | 0.76 (0.65-0.88), <0.01 |
| aMean (95% CI), p-value | |||
| Variable | 2010 | 2013 | 2016 |
| Additional Costs | $4,413(428-8397), 0.03 | $691(-2633-4016), 0.68 | $97(-3269-3462), 0.96 |
| Additional Charges | $20,750(7545-33956), <0.01 | $18,411(6430 - 30393), <0.01 | $21,918(10018-33818), <0.01 |
| Additional Length of Stay (days) | 1.7(0.16-3.23), 0.03 | -0.46(-1.55 - 0.64), 0.41 | -1.09 (-2.16 - -0.03), 0.04 |
Adjusted odds ratios and additional adjusted means for the evaluated variables in patients with Crohn's disease who underwent cholecystectomy in 2016, 2013 and 2010 compared to patients with Crohn's disease who underwent cholecystectomy in 2007.
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