PATIENTS ADMITTED WITH ACUTE CHOLECYSTITIS AND ASSOCIATED COVID 19 HAD LESS RATES OF SAME ADMISSION CHOLECYSTECTOMY BUT NOT INCREASED MORTALITY
Pedro Palacios Argueta*1, Frank Lukens1, Donghyun Ko2, Do Han Kim2, Miguel Salazar3, Enrique F. Elli1, Paul T. Kröner4
1Mayo Clinic in Florida, Jacksonville, FL; 2Universidad Francisco Marroquin, Guatemala City, Guatemala, Guatemala; 3University of California Riverside, Riverside, CA; 4Riverside Health System, Newport News, VA
Background
Acute Cholecystitis (AC) is a common condition encountered in the hospital setting. Standard of treatment is surgical however during the beginning of the COVID-19 pandemic management of many conditions changed. The aim of this study is to evaluate the outcomes of patients with AC and COVID-19.
Methods
Retrospective cohort study of the 2020 National Inpatient Sample (NIS) using ICD10-CM/PCS codes to identify patients discharged for AC. Patients were divided in those with associated COVID-19 vs. those without COVID-19. Primary outcomes were: mortality, morbidity (mechanical ventilation / shock), rates of same admission cholecystectomy (CCY), rates of percutaneous cholecystostomy (PC). Secondary outcomes were: length of stay (LOS), early CCY (≤72hrs), need for Endoscopic retrograde cholangiopancreatography (ERCP), acute kidney injury (AKI) health-care related charges and costs. Multivariate regression analysis adjusted for patient and hospital characteristics was performed for the primary and secondary outcomes
Results
A total of 35,870 discharges for AC were identified, out of which 0.15% (N= 540) had associated COVID-19. Patients with associated COVID-19 were more likely to be Hispanic (40.6% vs. 16.2%; P<0.01), to have Medicaid as primary payer (23.1% vs. 16.6%; P<0.01) and higher rates of PC (17.6% vs. 109%; P=0.04). They were less likely to have same admission CCY (31.5% vs. 65.9%; P<0.01) and to undergo early CCY (28.7% vs. 59.5%; P<0.01). Patients with AD and associated COVID-19 had longer LOS (5.1 days vs. 3.8 days; P=0.03). There were no significant differences regarding age, sex, Charlson Comorbidity Index Score, median annual income and hospitalization costs and charges.
After adjusting for confounders, patients with COVID 19 had less odds for same admission CCY [adjusted odds ratio [aOR] 0.27, 95% confidence interval [CI] (0.08 – 0.86)] and early CCY [aOR 0.008 (0.006 - 0.01)]. They did not have increase odds of mortality [aOR 3.17 (0.61 – 16.59)], PC [0.81 (0.44-1.51)], LOS [aOR 1.32 (0.30 – 2.34)], AKI [aOR 1.01 (0.51 – 2.02)], mechanical ventilation [aOR 1.20 (0.16 – 9.29)], shock [aOR 1.00], ERCP [aOR 0.41 (0.06 – 3.02)], hospitalization charges [aUS$ 11,014 (-1,426 – 23,455)], and costs [aUS$ 2,068 (-741 – 4,877)].
Conclusion
The incidence of AC in patients with COVID-19 was 0.15% with higher rates in Hispanics. Patients with AC and COVID-19 had significant lower odds of same admission CCY without increased in-hospital mortality. This likely to a less severe presentation and prompt conservative management.
Table 1. General characteristics of patients with acute cholecystitis
Table 2. Crude and Adjusted Odds for Primary and Secondary Outcomes of Patients Discharged with Acute Cholecystitis and associated COVID-19
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