OUTCOMES OF ACUTE GALLSTONE PANCREATITIS IN BARIATRIC SURGERY PATIENTS: DOES SAME ADMISSION CHOLECYSTECTOMY IMPROVE OUTCOMES?
Pedro Palacios Argueta1, Miguel Salazar1, Tyler Stevens2, John J. Vargo2, John Rodriguez2, Prabhleen Chahal2, C. Roberto Simons-Linares*2
1Cook County Health & Hospital System (CCHHS), Chicago, IL; 2Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH
Background
Bariatric surgery (BSx) is one of the most common surgical procedures performed in the United States. Obesity rates are on the rise and is very well known its association with gallstone acute pancreatitis (GAP). The literature is limited regarding if the change in anatomy from BSx poses an increase risk and worse outcomes in patients admitted with gallstone induced acute pancreatitis (GAP).
Methods
Cohort study of the 2016 National Inpatient Sample (NIS) using ICD10-CM/PCS codes to identify patients discharged with a primary diagnosis of GAP and those with history of BSx. Primary outcome was in-hospital mortality, same admission cholecystectomy (CCY). Secondary outcomes were length of stay (LOS), acute kidney injury (AKI), mechanical ventilation, systemic inflammatory response (SIRS), hospital related charges and costs. Subgroup analysis was performed for those with same admission CCY for the same outcomes plus early CCY. Multivariate regression analysis to adjust for patient and hospital characteristics was performed for the primary and secondary outcomes.
Results
A total of 12,704 GAP patients were identify out of which 2.5% (n=325) had prior history of BSx. Patients with BSx when admitted with GAP were more likely to be female (75.3% vs. 58.8%: P<0.01), younger (48.8 mean years of age vs. 57.2; P<0.01), African American (27.8% vs. 10.8%; P<0.01), to have private insurance as primary payer (59.3% vs. 33.6%; P<0.01) and to have higher rates of same early CCY (56.9% vs. 40.1%). After adjusting for patient and hospital characteristics prior history of BSx had no significant difference on outcomes: mortality [1.00], CCY [aOR 0.60; P=0.34], AKI [aOR 0.70; P=0.54], mechanical ventilation [aOR 4.30 P=0.23], SIRS [aOR 1.14; P=0.85], LOS [aOR 0.60; P=0.34], total charges [3,982; P=0.35] and costs [11; P=0.99]. Subgroup analysis for those who underwent same admission CCY with prior history of bariatrics shows only significant difference on rates of early CCY [2.29; P=0.04] but no impact in other outcomes.
Conclusion
Prior history of bariatric surgery is not associated with worse outcomes in patients admitted with GAP and rates of CCY do not differ, though patients with prior history of BSx tend to have higher rates of earlier CCY than those that not, likely due an overall better clinical status and fitness related to BSx.
Table 1: General Characteristics
Table 2: Outcomes
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