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Evaluation of socioeconomic and healthcare disparities on same admission cholecystectomy after endoscopic retrograde cholangiopancreatography among patients with acute gallstone pancreatitis

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Abstract

Background

Despite literature and guidelines recommending same admission cholecystectomy (CCY) after endoscopic retrograde cholangiopancreatography (ERCP) for patients with acute gallstone pancreatitis, clinical practice remains variable. The aim of this study was to investigate the role of clinical and socio-demographic factors in the management of acute gallstone pancreatitis.

Methods

Patients with acute gallstone pancreatitis who underwent ERCP during hospitalization were reviewed from the U.S. Nationwide Inpatient Sample database between 2008 and 2014. Patients were classified by treatment strategy: ERCP + same admission CCY (ERCP + CCY) versus ERCP alone. Measured variables including age, race/ethnicity, Charlson Comorbidity Index (CCI), hospital type/region, insurance payer, household income, length of hospital stay (LOS), hospitalization cost, and in-hospital mortality were compared between cohorts using χ2 and ANOVA. Multivariable logistic regression was performed to identify specific predictors of same admission CCY.

Results

A total of 205,012 patients (ERCP + CCY: n = 118,318 versus ERCP alone: n = 86,694) were analyzed. A majority (53.4%) of patients that did not receive same admission CCY were at urban-teaching hospitals. LOS was longer with higher associated costs for patients with same admission CCY [(6.8 ± 5.6 versus 6.4 ± 6.5 days; P < 0.001) and ($69,135 ± 65,913 versus $52,739 ± 66,681; P < 0.001)]. Mortality was decreased significantly for patients who underwent ERCP + CCY versus ERCP alone (0.4% vs 1.1%; P < 0.001). Multivariable regression demonstrated female gender, Black race, higher CCI, Medicare payer status, urban-teaching hospital location, and household income decreased the odds of undergoing same admission CCY + ERCP (all P < 0.001).

Conclusion

Based upon this analysis, multiple socioeconomic and healthcare-related disparities influenced the surgical management of acute gallstone pancreatitis. Further studies to investigate these disparities are indicated.

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References

  1. Peery AF, Crockett SD, Barritt AS et al (2015) Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology 149(7):1731-1741.e1733

    Article  Google Scholar 

  2. Peery AF, Crockett SD, Murphy CC et al (2019) Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2018. Gastroenterology 156(1):254-272.e211

    Article  Google Scholar 

  3. Crockett SD, Wani S, Gardner TB, Falck-Ytter Y, Barkun AN, American Gastroenterological Association Institute Clinical Guidelines Committee (2018) American Gastroenterological Association Institute guideline on initial management of acute pancreatitis. Gastroenterology 154(4):1096–1101

    Article  Google Scholar 

  4. Forsmark CE, Baillie J, AGA Institute Clinical Practice and Economics Committee, AGA Institute Governing Board (2007) AGA Institute technical review on acute pancreatitis. Gastroenterology 132(5):2022–2044

    Article  CAS  Google Scholar 

  5. Gullo L, Migliori M, Olah A et al (2002) Acute pancreatitis in five European countries: etiology and mortality. Pancreas 24(3):223–227

    Article  Google Scholar 

  6. Forsmark CE, Vege SS, Wilcox CM (2016) Acute pancreatitis. N Engl J Med 375(20):1972–1981

    Article  CAS  Google Scholar 

  7. Najafian N, McCarty TR (2018) Empagliflozin-associated pancreatitis: a case report and clinical review of drug-induced pancreatitis. Conn Med 82(9):543–546

    Google Scholar 

  8. Lerch MM, Saluja AK, Runzi M, Dawra R, Saluja M, Steer ML (1993) Pancreatic duct obstruction triggers acute necrotizing pancreatitis in the opossum. Gastroenterology 104(3):853–861

    Article  CAS  Google Scholar 

  9. Opie EL, Meakins JC (1909) Data concerning the etiology and pathology of hemorrhagic necrosis of the pancreas (acute hemorrhagic pancreatitis). J Exp Med 11(4):561–578

    Article  CAS  Google Scholar 

  10. Opie EL (1901) The etiology of acute hemorrhagic pancreatitis. Bull Johns Hopkins Hosp 12:182

    Google Scholar 

  11. Neoptolemos JP (1989) The theory of ‘persisting’ common bile duct stones in severe gallstone pancreatitis. Ann R Coll Surg Engl 71(5):326–331

    CAS  PubMed  PubMed Central  Google Scholar 

  12. ASoP Committee, Buxbaum JL, Abbas Fehmi SM et al (2019) ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc 89(6):1075–1105.e1015.

  13. Uhl W, Muller CA, Krahenbuhl L, Schmid SW, Scholzel S, Buchler MW (1999) Acute gallstone pancreatitis: timing of laparoscopic cholecystectomy in mild and severe disease. Surg Endosc 13(11):1070–1076

    Article  CAS  Google Scholar 

  14. Uhl W, Warshaw A, Imrie C et al (2002) IAP guidelines for the surgical management of acute pancreatitis. Pancreatology 2(6):565–573

    Article  Google Scholar 

  15. Heij HA, Veen HF, Eggink WF, Obertop H (1985) Timing of surgery for acute biliary pancreatitis. Am J Surg 149(3):371–374

    Article  CAS  Google Scholar 

  16. Ranson JH (1979) The timing of biliary surgery in acute pancreatitis. Ann Surg 189(5):654–663

    Article  CAS  Google Scholar 

  17. Tondelli P, Stutz K, Harder F, Schuppisser JP, Allgower M (1982) Acute gallstone pancreatitis: best timing for biliary surgery. Br J Surg 69(12):709–710

    Article  CAS  Google Scholar 

  18. da Costa DW, Bouwense SA, Schepers NJ et al (2015) Same admission versus interval cholecystectomy for mild gallstone pancreatitis (PONCHO): a multicentre randomised controlled trial. Lancet 386(10000):1261–1268

    Article  Google Scholar 

  19. da Costa DW, Dijksman LM, Bouwense SA et al (2016) Cost-effectiveness of same admission versus interval cholecystectomy after mild gallstone pancreatitis in the PONCHO trial. Br J Surg 103(12):1695–1703

    Article  Google Scholar 

  20. Leppaniemi A, Tolonen M, Tarasconi A et al (2019) 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg 14:27

    Article  Google Scholar 

  21. Tenner S, Baillie J, DeWitt J, Vege SS, American College of Gastroenterology (2013) American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol 108(9):1400–1415; 1416

  22. IAP/APA Acute Pancreatitis Guidelines Working Group (2013) IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 13(4 Suppl 2):e1–e15

    Google Scholar 

  23. Rebours V, Levy P, Bretagne JF, Bommelaer G, Hammel P, Ruszniewski P (2012) Do guidelines influence medical practice? Changes in management of acute pancreatitis 7 years after the publication of the French guidelines. Eur J Gastroenterol Hepatol 24(2):143–148

    Article  Google Scholar 

  24. Nguyen GC, Tuskey A, Jagannath SB (2008) Racial disparities in cholecystectomy rates during hospitalizations for acute gallstone pancreatitis: a national survey. Am J Gastroenterol 103(9):2301–2307

    Article  Google Scholar 

  25. Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP): advancing excellence in health care. https://www.ahrq.gov/research/data/hcup/index.html. Accessed 11 Nov 2019

  26. McCarty TR, Echouffo-Tcheugui JB, Lange A, Haque L, Njei B (2018) Impact of bariatric surgery on outcomes of patients with nonalcoholic fatty liver disease: a nationwide inpatient sample analysis, 2004–2012. Surg Obes Relat Dis 14(1):74–80

    Article  Google Scholar 

  27. Bilal M, Kline KT, Trieu JA et al (2019) Trends in same admission cholecystectomy and endoscopic retrograde cholangiopancreatography for acute gallstone pancreatitis: a nationwide analysis across a decade. Pancreatology 19(4):524–530

    Article  Google Scholar 

  28. Healthcare Cost and Utilization Project (HCUP). Overview of National (Nationwide) Inpatient Sample (NIS). Accessed 15 Dec 2019

  29. Tse F, Yuan Y (2012) Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. Cochrane Database Syst Rev (5):CD009779

  30. Banks PA, Bollen TL, Dervenis C et al (2013) Classification of acute pancreatitis—2012: revision of the Atlanta Classification and definitions by international consensus. Gut 62(1):102–111

    Article  Google Scholar 

  31. Kadiyala V, Suleiman SL, McNabb-Baltar J, Wu BU, Banks PA, Singh VK (2016) The Atlanta Classification, Revised Atlanta Classification, and determinant-based classification of acute pancreatitis: which is best at stratifying outcomes? Pancreas 45(4):510–515

    Article  Google Scholar 

  32. Campbell EJ, Montgomery DA, MacKay CJ (2007) A survey of current surgical treatment of acute gallstone disease in the west of Scotland. Scott Med J 52(4):15–19

    Article  CAS  Google Scholar 

  33. Campbell EJ, Montgomery DA, Mackay CJ (2008) A national survey of current surgical treatment of acute gallstone disease. Surg Laparosc Endosc Percutan Tech 18(3):242–247

    Article  Google Scholar 

  34. Ong SK, Christie PM, Windsor JA (2003) Management of gallstone pancreatitis in Auckland: progress and compliance. ANZ J Surg 73(4):194–199

    Article  Google Scholar 

  35. Gollust SE, Cunningham BA, Bokhour BG et al (2018) What causes racial health care disparities? A mixed-methods study reveals variability in how health care providers perceive causal attributions. Inquiry 55:46958018762840

    PubMed  Google Scholar 

  36. Loehrer AP, Song Z, Auchincloss HG, Hutter MM (2015) Influence of health insurance expansion on disparities in the treatment of acute cholecystitis. Ann Surg 262(1):139–145

    Article  Google Scholar 

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Funding

This work was funded, at least in part, by the NIH Grant T32 DK007533-35.

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Authors and Affiliations

  1. Yale University School of Medicine, New Haven, CT, USA

    Fouad Chouairi

  2. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Thomas R. McCarty, Kelly E. Hathorn & Christopher C. Thompson

  3. Section of Gastroenterology, Yale-New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA

    Prabin Sharma

  4. Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA

    Harry R. Aslanian, Priya A. Jamidar & Thiruvengadam Muniraj

Authors
  1. Fouad Chouairi
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  2. Thomas R. McCarty
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Correspondence to Thiruvengadam Muniraj.

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Disclosures

Christopher C Thompson has the following disclosures: Apollo Endosurgery: Consultant/Research Support (Consulting fees/Institutional Research Grants), Aspire Bariatrics: Research Support (Institutional Research Grant), BlueFlame Healthcare Venture Fund: General Partner, Boston Scientific: Consultant (Consulting fees), Covidien/Medtronic: Consultant (Consulting Fees), EnVision Endoscopy (Board Member), Fractyl: Consultant/Advisory Board Member (Consulting Fees), GI Dynamics: Consultant (Consulting Fees)/Research Support (Institutional Research Grant), GI Windows: Ownership interest, Olympus/Spiration: Consultant (Consulting Fees)/Research Support (Equipment Loans), Spatz: Research Support (Institutional Research Grant), USGI Medical: Consultant (Consulting Fees)/Advisory Board Member (Consulting fees)/Research Support (Research Grant). Thiruvengadam Muniraj has the following disclosures: Boston Scientific: Consultant. Fouad Chouairi, Thomas R. McCarty, Kelly Hathorn, Prabin Sharma, Harry R. Aslanian, and Priya Jamidar have no conflicts of interest or financial ties to disclose.

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Chouairi, F., McCarty, T.R., Hathorn, K.E. et al. Evaluation of socioeconomic and healthcare disparities on same admission cholecystectomy after endoscopic retrograde cholangiopancreatography among patients with acute gallstone pancreatitis. Surg Endosc 36, 274–281 (2022). https://doi.org/10.1007/s00464-020-08272-2

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