Racial Disparities in Access and Outcomes of Cholecystectomy in the United States

Gahagan, John V.; Hanna, Mark; Whealon, Matthew D.; Maximus, Steven; Phelan, Michael; Lekawa, Michael; Barrios, Cristobal; Bernal, Nicole P.

doi:10.1177/000313481608201013

Cited by 26 publications

(8 citation statements)

References 18 publications

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“…cholecystectomies, but men tend to have more complex and longer procedures which may explain their less favorable outcomes. 28,29 In agreement with our findings, Carbonell et al found in a US-nationwide study in 2000 that male gender was linked to higher charges, longer LOS, and increased morbidity and mortality after cholecystectomy. 3 Black race was an independent predictor for increased LOS and total cost.…”

Section: Ijmssupporting

confidence: 92%

Trends and Factors Impacting Healthcare Charges and Length of Stay for Cholecystectomies: A New York State Population-based Analysis

Darbandi¹,

Chopra²

2021

Int J Med Students

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Background: Gallbladder disease confers a significant economic toll on the United States healthcare system. This study aims to characterize current trends and features of the cholecystectomy population and identify factors that influence the length of stay and total charges. Methods: Case information was extracted for laparoscopic and open cholecystectomies from 2013-2016 using the New York Statewide Planning and Research Cooperative System (SPARCS) database. Descriptive, comparative, and multivariable linear regression analysis was conducted on 58,141 cases assessing age group, race, gender, admission presentation, surgical technique, insurance status, year of operation and severity of illness by the length of stay and total charges. Results: Of all procedures, 91.6% were laparoscopic, and 79.4% were emergent on admission. Total procedures trended down, while laparoscopic and emergent cases steadily increased (p<0.0001). Total charges increased during the study period, while the length of stay decreased (p<0.0001). Open and emergent procedures were associated with a higher cost and longer inpatient stays (p<0.0001). Open procedures were proportionally more common among elderly, male patients, and elective cases (p<0.0001). Emergent presentation was more common in females, non-whites, and younger patients (p<0.0001). Regression model showed that male gender, open operation, Black race, and emergent presentation were independent predictors for a longer stay and greater total charges (p<0.0001). Medicare insurance predicted lower total charges but longer length of stay (p<0.0001). Conclusion: Race, insurance, procedure type, and patient presentation influence hospital charges and stays following cholecystectomy. Understanding these trends will allow policymakers and providers to limit the healthcare burden of cholecystectomy.

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Section: Ijmssupporting

confidence: 92%

Trends and Factors Impacting Healthcare Charges and Length of Stay for Cholecystectomies: A New York State Population-based Analysis

Darbandi¹,

Chopra²

2021

Int J Med Students

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“…However, these results may have been influenced by confounding if healthier patients were more likely to undergo an earlier operation. In addition, evidence from 243 536 patients in the US Nationwide Inpatient Sample database showed that non-White patients had higher rates of emergent admission compared with White patients (84% vs 78%, respectively; P < .001), suggesting there are disparities in health care access for non-White patients who have acute cholecystitis . In summary, early cholecystectomy was associated with significantly better outcomes than delayed cholecystectomy …”

Section: Treatmentmentioning

confidence: 96%

“…In addition, evidence from 243 536 patients in the US Nationwide Inpatient Sample database showed that non-White patients had higher rates of emergent admission compared with White patients (84% vs 78%, respectively; P < .001), suggesting there are disparities in health care access for non-White patients who have acute cholecystitis. 70 In summary, early cholecystectomy was associated with significantly better outcomes than delayed cholecystectomy. [66][67][68][69] Approximately 2% to 15% of patients undergoing laparoscopic cholecystectomy must be converted to open cholecystectomy.…”

Section: Early Vs Delayed Cholecystectomymentioning

confidence: 99%

Acute Cholecystitis

Gallaher

Charles

2022

JAMA

213

125

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cute cholecystitis is an acute inflammatory disease of the gallbladder that is caused by gallstone obstruction of the cystic duct in approximately 90% to 95% of people diagnosed with this condition. 1 Less commonly, acalculous cholecystitis, in which acute inflammation of the gallbladder develops without gallstones, is present in approximately 5% to 10% of people diagnosed with acute cholecystitis.Gallbladder disease affects approximately 20 million individuals in the US and results in estimated direct annual costs of more than $6.3 billion, with more than 200 000 people diagnosed with acute cholecystitis each year. [2][3][4] Of the 10% to 15% of adults in the US general population with cholelithiasis, approximately 80% are asymptomatic. 5 Twenty percent of patients with gallstones will eventually develop gallstone-related complications at an incidence rate of 1% to 4% annually, with calculous acute cholecystitis as the first clinical presentation in 10% to 15% of all patients with gallstones. 6 In contrast, the etiology of acalculous acute cholecystitis, defined as an acute inflammatory disease of the gallbladder in the absence of cholelithiasis, is multifactorial. Factors associated with acalculous acute cholecystitis include critical illness, diabetes, HIV infection, atherosclerosis, and total parenteral nutrition. 7,8 Acalculous acute cholecystitis is present in approximately 5% to 10% of patients presenting with acute cholecystitis. Acalculous IMPORTANCE Gallbladder disease affects approximately 20 million people in the US. Acute cholecystitis is diagnosed in approximately 200 000 people in the US each year.OBSERVATIONS Gallstone-associated cystic duct obstruction is responsible for 90% to 95% of the cases of acute cholecystitis. Approximately 5% to 10% of patients with acute cholecystitis have acalculous cholecystitis, defined as acute inflammation of the gallbladder without gallstones, typically in the setting of severe critical illness. The typical presentation of acute cholecystitis consists of acute right upper quadrant pain, fever, and nausea that may be associated with eating and physical examination findings of right upper quadrant tenderness. Ultrasonography of the right upper quadrant has a sensitivity of approximately 81% and a specificity of approximately 83% for the diagnosis of acute cholecystitis. When an ultrasound result does not provide a definitive diagnosis, hepatobiliary scintigraphy (a nuclear medicine study that includes the intravenous injection of a radiotracer excreted in the bile) is the gold standard diagnostic test. Following diagnosis, early (performed within 1-3 days) vs late (performed after 3 days) laparoscopic cholecystectomy is associated with improved patient outcomes, including fewer composite postoperative complications (11.8% for early vs 34.4% for late), a shorter length of hospital stay (5.4 days vs 10.0 days), and lower hospital costs. During pregnancy, early laparoscopic cholecystectomy, compared with delayed operative management, is associated with a lower risk of ...

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“…Socioeconomic disparities in outcomes after cholecystectomies exist, and uninsured patients and minorities have been shown to be more likely to undergo emergency surgery. 8 Barriers to health-care access in these populations may subsequently increase LOS, costs, and complications. Younger patients at CHs may have longer LOS because of issues with postoperative pain tolerance, slower recovery times, or more conservative healthcare team members.…”

Section: Discussionmentioning

confidence: 99%

Impact of Children's Hospital Designation on Outcomes and Costs after Cholecystectomy in Adolescent Patients

Tom

Won

Friedlander

et al. 2018

The American Surgeon™

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Variations in the management of adolescents at children's hospitals (CHs) and nonchildren's hospitals (NCHs) have been well described in the trauma literature. However, the effects of CH designation on outcomes after common general surgical procedures have not been investigated. The purpose of this study was to compare the outcomes and costs of adolescent cholecystectomies performed at CHs and NCHs. Within the California State Inpatient Database (2005–2011), we identified 8117 cholecystectomy patients aged 13 to 18 years at CHs and NCHs. Outcomes (laparoscopy, intraoperative cholangiogram, length of stay (LOS), and complications) and costs were analyzed. CHs cared for younger patients, more uninsured patients, and more black patients. NCHs were associated with higher laparoscopy use (95.7% vs 88.3%, P < 0.01), higher intra-operative cholangiogram rates (28.8% vs 11.9%, P < 0.001), shorter LOS (3.2 vs 5.0 days, P < 0.01), and lower costs by $5797 per patient ($11,219 vs $17,016, P < 0.01). Although there was no significant difference in overall complication rates, CHs had higher rates of infectious complications (2.0% vs 1.0%, P = 0.004). Adolescent cholecystectomies are safely performed at NCHs while achieving increased laparoscopy use, shorter LOS, and lower costs compared with CHs.

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Racial Disparities in Access and Outcomes of Cholecystectomy in the United States

Cited by 26 publications

References 18 publications

Trends and Factors Impacting Healthcare Charges and Length of Stay for Cholecystectomies: A New York State Population-based Analysis

Trends and Factors Impacting Healthcare Charges and Length of Stay for Cholecystectomies: A New York State Population-based Analysis

Acute Cholecystitis

Impact of Children's Hospital Designation on Outcomes and Costs after Cholecystectomy in Adolescent Patients

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