EARLY CHOLECYSTECTOMY DURING INDEX ADMISSION FOR GALLSTONE ACUTE PANCREATITIS LOWERS 30-DAY READMISSION RATES AND IMPROVES OUTCOMES
Pedro Palacios Argueta*1, Miguel Salazar1, John Rodriguez2, Tyler Stevens2, John J. Vargo2, Prabhleen Chahal2, C. Roberto Simons-Linares2
1Cook County Health & Hospital System (CCHHS), Chicago, IL; 2Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH
Background
Gallstone acute pancreatitis (GAP) is among the most common causes of acute pancreatitis in the United states. Timing of cholecystectomy (CCY) in this set of patients is controversial and data is very limited regarding its effect on hospital readmissions. We sought to investigate how timing of CCY impacts hospital readmissions and predictors for readmissions that could be targeted.
Methods
Cohort study using the 2016 National Readmission Database (NRD) of adult patients readmitted to the hospital after an index admission of GAP. ICD-10CM/PCS codes were used to identify GAP, other comorbidities and procedures. Early CCY was defined as CCY performed ≤72 hours of the hospitalization course and multivariate Cox regression analysis was used to identify predictors of readmission and adjust for patient and hospital characteristics.
Results
A total of 8,026 patients were discharge with a primary diagnosis of GAP, out of which 8.8% (n=718) were readmitted within 30 days of discharge. 56.5 % of patients underwent CCY during index admission and 38.9% underwent early CCY. The 30-day readmission rate for patients that underwent early CCY was 4.7% compared to 9.5% to those whose did not (P<0.01). Early CCY was associated with lower hospital length of stay (-4.5 days; P<0.01), mean hospital charges ($-31,780; P=<0.01) and costs ($-7,469; P=<0.01). Early CCY was also associated with lower adjusted odds of 30-day readmission risk (aOR 0.55; P<0.01), as well as female gender (aOR 0.78; P=0.02) and same admission CCY (aOR 0.7; P=0.04).
Conclusion
Early CCY should be considered in patients with GAP when possible in order to lower hospital readmission rates and alleviate the burden that readmissions praise on the healthcare system.
Table 1: General Characteristics
Table 2 : Predictors of Readmission
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