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Impact of hospital characteristics on best-practice adherence for gallstone pancreatitis: a nationwide analysis

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Abstract

Background

Current guidelines recommend cholecystectomy during the index admission for gallstone pancreatitis, and a growing body of evidence indicates that patients benefit from cholecystectomy within the first 48 h of admission. We examined the impact of hospital characteristics on adherence to these data-driven practices.

Methods

We queried the National Inpatient Sample for patients admitted for gallstone pancreatitis between October 2015 and December 2018. Patients who underwent same-admission cholecystectomy were identified by procedure codes. Cholecystectomies within the first two days were classified as early cholecystectomies. Multivariable logistic regression was used to determine the association between hospital characteristics and adherence to these practices.

Results

Of 163,390 admissions for gallstone pancreatitis, only 90,790 (55.6%) underwent cholecystectomy before discharge. Mean time from admission to cholecystectomy was 2.9 days; 27.0% of patients (44,005) underwent early cholecystectomy. Odds of same-admission cholecystectomy were highest in large hospitals (OR 1.21, 95% CI 1.13–1.28), urban teaching centers (OR 1.33, 95% CI 1.21–1.46), and the South (OR 1.70, 95% CI 1.57–1.83). Odds of early cholecystectomy did not vary with hospital size, urban–rural status, or teaching status but were highest in the West (OR 1.98, 95% CI 1.80–2.18).

Conclusion

Best-practice adherence for cholecystectomy in gallstone pancreatitis remains low despite an abundance of evidence and clinical practice guidelines. Active interventions are needed to improve delivery of surgical care for this patient population. Implementation efforts should focus on small hospitals, rural areas, and health systems in the Northeast region.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    James C. Etheridge, Manuel Castillo-Angeles & Joaquim M. Havens

  2. Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    James C. Etheridge, Robert D. Sinyard & Joaquim M. Havens

  3. Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA

    Manuel Castillo-Angeles, Molly P. Jarman & Joaquim M. Havens

  4. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA

    Robert D. Sinyard

Authors
  1. James C. Etheridge
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  2. Manuel Castillo-Angeles
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  3. Robert D. Sinyard
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  4. Molly P. Jarman
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  5. Joaquim M. Havens
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Corresponding author

Correspondence to James C. Etheridge.

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Disclosures

Drs. James Etheridge, Manuel Castillo-Angeles, Robert Sinyard, Molly Jarman, and Joaquim Havens have no conflicts of interest or financial ties to declare.

Ethical approval

This study was conducted with ethical approval from the Mass General Brigham Institutional Review Board, #2015P001722.

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Etheridge, J.C., Castillo-Angeles, M., Sinyard, R.D. et al. Impact of hospital characteristics on best-practice adherence for gallstone pancreatitis: a nationwide analysis. Surg Endosc 37, 127–133 (2023). https://doi.org/10.1007/s00464-022-09444-y

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  • DOI: https://doi.org/10.1007/s00464-022-09444-y

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