SOCIOECONOMIC AND HEALTHCARE DISPARITIES AMONG PATIENTS TREATED FOR ACUTE CHOLECYSTITIS: A COMPARISON OF CHOLECYSTECTOMY VERSUS PERCUTANEOUS CHOLECYSTOSTOMY
Thomas R. McCarty*1, Fouad Chouairi2, Kelly Hathorn1, Prabin Sharma3, Thiruvengadam Muniraj2, Christopher C. Thompson1
1Brigham & Women's Hospital, Boston, MA; 2Yale University School of Medicine, New Haven, CT; 3Yale-New Haven Health-Bridgeport Hospital, Bridgeport, CT
Background:
Acute cholecystitis represents a significant healthcare burden affecting approximately 10% to 15% of United States adults. While surgical resection is considered standard of care, several patients may not be considered good surgical candidates for cholecystectomy (CCY) and instead undergo percutaneous cholecystostomy (PC). Reports on disparities in utilization of these two treatment options remain limited. The primary aim of this study was to investigate the roles of demographic, clinical, and socioeconomic factors in treatment of acute cholecystitis.
Methods:
Patients with a diagnosis of acute cholecystitis were reviewed from the Nationwide Inpatient Sample (NIS) database between 2008 and 2014. Calculous and acalculous cholecystitis were identified by International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes with patients classified by type of treatment: open or laparoscopic CCY vs PC. Patients who received both treatments during the same hospitalization were excluded. Measured variables including age, race/ethnicity, comorbidities, hospital type, hospital region, insurance payer type, median household income quartile, length of hospital stay, total cost, and mortality were compared between cohorts using chi-squared and ANOVA. A multivariable logistic regression was performed to identify specific predictors of cholecystitis treatment.
Results:
A total of 1,509,266 patients were analyzed (CCY: n=1,451,609 patients vs PC: n=57,657 patients) in this study. Baseline patient and hospital characteristics are highlighted in Table 1. A majority of patients that received PC were at urban teaching hospitals (65.3%). Length of hospital stay was significantly longer with higher associated costs for PC [(11.1±11.0 days vs 4.4±5.4; P<0.001) and ($99601±138840 vs $48328±58843; P<0.001), respectively]. Mortality was also increased for patients that received PC compared to CCY (8.8% vs 0.6%; P<0.001). Multivariable logistic regression demonstrated multiple socioeconomic and healthcare-related factors that influenced the utilization of PC including older age, male gender, black race, urban hospital location, Medicaid insurance status, and household income (all P<0.001) – Table 2.
Conclusion:
Although patients receiving percutaneous cholecystostomy were more ill, being older with more comorbidities, Medicaid insurance, black race/ethnicity, urban teaching hospital setting and Northeast location appeared to also factor into this treatment decision. Additional studies to investigate these socioeconomic and healthcare disparities are indicated to improve the outcomes for all individuals with this condition.
Table 1: Baseline Patient and Hospital Characteristics: Cholecystectomy Versus Cholecystostomy
Table 2: Multivariable Logistic Regression – Predictors of Cholecystostomy as Compared to Cholecystectomy
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