SAFETY AND INPATIENT OUTCOMES OF ACUTE CHOLECYSTITIS IN PATIENTS WITH LIVER CIRRHOSIS: SAME ADMISSION CHOLECYSTECTOMY DOES NOT INCREASE MORTALITY.
Pedro Palacios Argueta1, Miguel Salazar1, Bashar M. Attar1, Zohaib Haque1, John Rodriguez2, John J. Vargo2, Prabhleen Chahal2, C. Roberto Simons-Linares*2
1Cook County Health & Hospital System (CCHHS), Chicago, IL; 2Cleveland Clinic, Cleveland, OH
Background.
There is limited data regarding outcomes of patients with cirrhosis when hospitalized for acute calculous cholecystitis (ACC). It is controversial if the presence of cirrhosis is associated with worse outcomes in patients with ACC. The aim of the present study is to study the incidence of ACC in cirrhotics and its impact on outcomes according to liver disease severity.
Methods
Historical cohort study using the 2016 National Inpatient Sample (NIS) using ICD10-CM/PCS codes to identify patients discharged with a primary diagnosis of ACC and those with secondary diagnosis of cirrhosis. Outcomes were: in-hospital mortality, same admission cholecystectomy (CCY) rates, length of stay (LOS), acute kidney injury (AKI), mechanical ventilation, systemic inflammatory response (SIRS), hospital related charges and costs. We compare non-cirrhotics (ref) with compensated and decompensated cirrhotics (defined as per the BAVENO score). Subgroup analysis was performed for those with same admission CCY. Early CCY was defined if performed ≤72 hours from admission time. Multivariate regression analysis to adjust for patient and hospital characteristics was performed.
Results
A total of 263,754 discharges for ACC were identified out of which 2.1% (n=5,659) had secondary diagnosis of cirrhosis. Patients with cirrhosis were more likely to be male ( 64.0% vs. 40.3%; P<0.01), older (mean age in years 60.1 vs. 54.9; P<0.01), to be Native American (1.6% vs 0.6%; P<0.01), to be tobacco smokers (2.5% vs 1.4%;P<0.01), cannabis users (2.3% vs 1.2%;P<0.01), alcohol abusers (19.8% vs 2.3%;P<0.01) and to have type 2 diabetes (38.8% vs 19.9%;P<0.01). Decompensated cirrhotics were more likely to undergo same-admission CCY (49.7% vs 83.6%; P<0.01) but were less likely to undergo early CCY (41.2% vs 74.0 %; P<0.01). Overall, cirrhotics were more likely to undergo ERCP (10.8% vs 17.2%; P<0.01) compared to non-cirrhotics. After adjusting for confounders, compensated and decompensated cirrhotics had lower rates of same-admission CCY (aOR 0.54; P<0.01) (aOR 0.34; P<0.01) respectively. Decompensated cirrhosis had higher total hospital charges (aOR $7,701; P<0.01) and costs (aOR $2,054; P<0.01). In those patients that underwent same-admission CCY, there was no difference in mortality between compensated cirrhosis (aOR 0.63; P=0.52) and decompensated cirrhosis (aOR 0.87 P=0.89). Compensated cirrhotics had higher rates of early CCY (aOR 1.30; P=0.04) than those with decompensated cirrhosis.
Conclusion
Hospitalized compensated and decompensated cirrhotics with ACC had similar mortality and undergo similar rates of CCY when compared to non-cirrhotics. Additionally, compensated cirrhotics were more likely to undergo earlier CCY compared to decompensated cirrhotics, probably due to their more optimized medical status. Hence, same-admission CCY appears safe in cirrhotics hospitalized with ACC
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