Epidemiology and outcomes of choledocholithiasis and cholangitis in the United States: trends and urban-rural variations

Abstract

Background Gallstone disease poses a significant health burden in the United States. Choledocholithiasis and cholangitis are common complications of gallstone disease for which data on current epidemiological trends are lacking. We aimed to evaluate temporal changes in hospitalization, management, and outcomes for patients with choledocholithiasis and cholangitis. Methods The National Inpatient Sample was used to identify discharges for choledocholithiasis and cholangitis between 2005 and 2014. Temporal trends were evaluated via annual percent changes (APCs). Joinpoint regression was used to assess inflection points. Multivariable regression models were used to evaluate associations of interest. Results From 189,362 unweighted discharges for choledocholithiasis and/or cholangitis, there was an increase in discharges for choledocholithiasis (APC 2.3%, 95% confidence intervals, CI, 1.9–2.7%) and cholangitis (APC 1.5%, 95% CI 0.7–2.2%). Procedural interventions were more likely at urban hospitals for choledocholithiasis (adjusted odds ratio, aOR, 2.94, 95% CI 2.72 to 3.17) and cholangitis (aOR 2.97, 95% CI 2.50 to 3.54). In-hospital mortality significantly decreased annually for choledocholithiasis (aOR 0.90, 95% CI 0.88 to 0.93) and cholangitis (aOR 0.93, 95% CI 0.89 to 0.97). In-hospital mortality between rural and urban centers was comparable for choledocholithiasis (aOR 1.16, 95% CI 0.89 to 1.52) and cholangitis (aOR 1.12, 95% CI 0.72 to 1.72). Conclusions Hospitalizations for choledocholithiasis and cholangitis have increased between 2005 and 2014, reflecting a growing burden of gallstone disease. Hospital mortality between urban and rural centers is similar, however urban centers have a higher rate of procedural interventions suggesting limitations to accessing procedural interventions at rural centers.

Treatment of Choledocholithiasis with Large Stones Through Biliary Tract Exploration and Instrumentation via a T-Tube

“…This chronic hepatobiliary ailment is characterized by irregularities in cholesterol, bilirubin, and bile acid metabolism (1). While cholelithiasis is prevalent, choledocholithiasis impacts roughly up to 20 % of individuals with this condition (5,6).…”

Comparative Analysis of Microbial Species and Multidrug Resistance Patterns in Acute Cholangitis Patients with Cholecystectomy: A Single-Center Study

“…Acute cholangitis has been increasingly associated with multidrug-resistant (MDR) organisms, complicating treatment strategies [1]. The prevalence of acute cholangitis has seen an upward trend, with studies indicating an increase in hospitalizations for cholangitis in the United States between 2005 and 2014, reflecting a growing burden of gallstone disease and associated complications [2][3][4]. This rise is paralleled by a growing concern over the emergence of MDR pathogens, which pose a significant threat to patient outcomes [5,6].…”

Non-Invasive Prediction of Choledocholithiasis Using 1D Convolutional Neural Networks and Clinical Data

“…It is estimated that between 10% and 20% of gallstone cases will present common bile duct stones (CBDSs) [ 1 , 2 ]. Various studies conducted worldwide have determined that the prevalence of this condition ranges from 9% to 21%, varying by region of study [ 3 , 4 , 5 ].…”