Early unplanned readmissions following same-admission cholecystectomy for acute biliary pancreatitis

Brandon K. Chu, Bipul Gnyawali, Jordan M. Cloyd, Phil A. Hart, Georgios I. Papachristou, Luis F. Lara, Jeffrey R. Groce, Alice Hinton, Darwin L. Conwell, Somashekar G. Krishna

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Same-admission cholecystectomy (CCY) is recommended for mild acute biliary pancreatitis (biliary-AP). However, there is a paucity of research investigating reasons for early (30-day) unplanned readmissions in patients who undergo CCY for biliary-AP. Hence, we sought to investigate this gap using a large population database. Methods: Using the Nationwide Readmission Database (2010–2014), we identified all adults (age ≥ 18 years) with a principal diagnosis of biliary-AP who had undergone CCY during the index hospitalization. Multivariable logistic regression models were obtained to assess independent predictors for 30-day readmission. Principal diagnosis for all readmissions was collected to ascertain the indications for early readmission. Results: During the study period, 118,224 patients underwent same-admission CCY for biliary-AP. Three-fourths of all patients underwent invasive cholangiography during the hospitalization (intraoperative cholangiogram (IOC) = 57,038, ERCP = 31,500). The rate of early (30-day) readmission was 7.25% (n = 8574). Exacerbation of prior medical conditions (42.2%), sequelae of biliary-AP (resolving and recurrent pancreatitis, pseudocysts) (27.6%), surgical site and other postoperative complications (16%), choledocholithiasis and/or bile leak (9.6%), and preventable hospital-acquired conditions (4.6%) accounted for early readmissions. On multivariable analysis, predictors for readmission included male sex (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.08–1.28), insurance type (Medicare insurance [OR 1.26, 95% CI 1.13–1.40]; Medicaid [OR 1.22, 95% CI 1.09–1.38]), outside-facility discharge (OR 1.35, 95% CI 1.16–1.57), severe AP (OR 1.35, 95% CI 1.21–1.50), and ≥ 3 Elixhauser comorbidities (OR 1.55, 95% CI 1.41–1.69). Performance of IOC (OR 0.90, 95% CI 0.82–0.97) and ERCP (OR 0.81, 95% CI 0.73–0.89) were associated with decreased risk of early readmission. Conclusion: In this study, using a national population database evaluating patients who underwent same-admission CCY after biliary-AP, we identified potentially modifiable risk factors and causes for early readmission as well as opportunities to improve clinical care.

Original languageEnglish
Pages (from-to)3001-3010
Number of pages10
JournalSurgical Endoscopy
Volume36
Issue number5
DOIs
StatePublished - May 2022

Bibliographical note

Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Keywords

  • Cholecystectomy
  • ERCP
  • Early Readmission
  • Gallstone Pancreatitis
  • Intraoperative cholangiogram

ASJC Scopus subject areas

  • Surgery

Fingerprint

Dive into the research topics of 'Early unplanned readmissions following same-admission cholecystectomy for acute biliary pancreatitis'. Together they form a unique fingerprint.

Cite this