Why are we performing fewer cholecystectomies for mild acute biliary pancreatitis? Trends and predictors of cholecystectomy from the National Readmissions Database (2010–2014)

Abstract

BackgroundCurrent guidelines recommend cholecystectomy for patients with mild acute biliary pancreatitis (MABP) during the index admission because it is associated with better outcomes. In this study, we aimed to assess national trends in cholecystectomy during index admissions for MABP and to identify factors associated with cholecystectomy completion and 30-day readmission.MethodsUsing diagnostic codes and the National Readmissions Database, we identified patients admitted with MABP between 2010 and 2014. Differences in cholecystectomy rates were computed on the basis of various characteristics. We conducted a multivariable analysis to identify factors associated with 30-day readmission and cholecystectomy during the same admission.ResultsWe identified 255,695 unique index MABP cases (41.3% male) and the 30-day readmission rate was 12.6%. Overall, 43.8% underwent cholecystectomy and 25% underwent endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy. We observed a decreasing trend in both procedures during the study period (P < 0.001). In multivariate analysis, odds of 30-day readmission were reduced for patients undergoing ERCP with sphincterotomy (odds ratio, 0.78; 95% confidence interval, 0.74–0.84) or cholecystectomy (odds ratio, 0.37; 95% confidence interval, 0.35–0.39).ConclusionsFor patients with MABP, cholecystectomy or ERCP with sphincterotomy during the index admission decreased the risk of 30-day readmission. Despite this benefit and national guidelines recommending cholecystectomy during the index MABP admission, the rate of cholecystectomies performed nationally decreased during the study period. Further research is needed to understand the implications and reasons underlying this deviation from guidelines.

Insufficient implementation of the IAP/APA guidelines on aetiology in acute pancreatitis: Is there a need for implementation managers in pancreatology?

“…In many countries, around 50% of patients receive antibiotics incorrectly 7,8 . Section L36 of the guidelines recommends index admission cholecystectomy, which is still not applied in most hospitals 9 …”

“…7,8 Section L36 of the guidelines recommends index admission cholecystectomy, which is still not applied in most hospitals. 9 All in all, it is extremely depressing that scientists spend a great deal of money on research and guidelines, but they do not appear in everyday practice. Based on these unpleasant data, it would appear to be high time to create a new post, that of implementation manager, responsible for strict adherence to management guidelines in order to ensure cost effectiveness and high quality in patient care.…”

Readmissions After Biliary Acute Pancreatitis: Analysis of the Nationwide Readmissions Database

“…Unfortunately, many studies showed poor adherence to recommended guidelines resulting in higher mortality and costs [10][11][12][13]. In addition, there was a trend of decreasing procedures for BAP between 2010 and 2014 [27].…”

Long-term outcome of patients with biliary pancreatitis not undergoing cholecystectomy. A retrospective study

“…In addition, deferral of surgery for over 4 weeks is a risk factor for further recurrent gallstone-related complications (13,14). Despite this, it is well known that almost half of diagnosed patients may not undergo immediate surgery following biliary pancreatitis (6,15). Furthermore, few reports have focused on patients who never undergo surgery.…”

“…Following diagnosis, cholecystectomy is recommended in virtually all international guidelines to prevent future episodes of acute pancreatitis (3)(4)(5). However, there is still in clinical practice a deviation from the guidelines available, as shown in the literature (6). Conversely, some patients will suffer a delay or will never be referred to surgery (7).…”