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RACIAL DISPARITIES IN THE RATE OF SAME-ADMISSION CHOLECYSTECTOMY FOLLOWING BILIARY PANCREATITIS
Brynne A. Ichiuji
*, Matthew Ashbrook, Vincent Cheng, Anaar Siletz, Matthew Martin, Kenji Inaba, Kazuhide Matsushima
Surgery, University of Southern California, Los Angeles, CA
Background
Same-admission cholecystectomy in mild and moderate biliary pancreatitis is known to be associated with reduced rates of recurrent biliary complications. While several practice guidelines recommend same-admission cholecystectomy, the contemporary management of mild and moderate biliary pancreatitis remains unknown. The objective of this study is to assess practice patterns of same-admission cholecystectomy following mild and moderate biliary pancreatitis.
Methods
The National Inpatient Sample was queried for patients aged ? 18 years with biliary pancreatitis between January 2016-December 2021. The Modified Bedside Index for Severity in Acute Pancreatitis was used to identify patients with mild and moderate pancreatitis as previously validated. Management strategies included non-operative management (NOM) and same-admission cholecystectomy. Multivariable Cox regression evaluated the association between clinical variables and same-admission cholecystectomy.
Results
In total, 482,705 patients with mild and moderate pancreatitis were identified with 283,435 (59%) undergoing same-admission cholecystectomy. Compared to White patients, Black patients were younger (54 years [IQR: 37-66 years] vs. 63 years [47-75 years], p<0.001), more likely to be female (30,720 [69%] vs. 167,885 [57%], p<0.001), and had lower Elixhauser Comorbid Index (ECI) (3 [0-10] vs 3 [0-10], p=0.013). Multivariable Cox regression showed that younger age (hazard ratio (HR) 0.993 per 1-year increment, 95% confidence interval (CI) 0.993-0.994, p<0.001), female sex (HR 1.157, 95% CI 1.136-1.178, p<0.001), lower ECI (HR 0.947, 95% CI 0.946-0.948, p<0.001), and White race as compared to Black race (HR 1.208, 95% CI 1.171-1.247, p<0.001) had increased likelihood of undergoing same-admission cholecystectomy.
Conclusions
Despite current recommendations, only 59% of patients with mild and moderate pancreatitis underwent same-admission cholecystectomy. More studies are warranted to understand potential drivers related to the racial disparities associated with the management of mild and moderate pancreatitis.
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