Skip to main content
SpringerLink
Log in

Effect of Medical or Surgical Admission on Outcome of Patients with Gallstone Pancreatitis and Common Bile Duct Stones

  • original paper
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Introduction

Management of uncomplicated common bile duct stone (CBDS) and gallstone pancreatitis (GP) presumably varies based on whether a patient is admitted to medicine or surgery. This study evaluates the impact of admitting team on outcome and cost.

Methods

Three hundred seventy patients admitted to the Massachusetts General Hospital for CBDS or GP were retrospectively analyzed for demographics, insurance status, procedures, complications, length of stay, readmission, and cost. A multivariable analysis was conducted for outcome and cost measures.

Results

Patients admitted to a surgical service were younger than those admitted to a medical service. Gender, race, tobacco use, and the presence of chronic obstructive pulmonary disease and chronic renal insufficiency were not significantly different between groups. Patients admitted to a medical service had a higher incidence of coronary artery disease and diabetes. Despite lower readmission rates for surgical patients, there was no difference in total hospital days between groups. Though total cost of an initial surgical admission was greater than a medical admission, total cost attributable to the index admission diminished over time and ultimately was not significant in follow-up.

Conclusions

Despite variations in uncomplicated management of CBDS and GP, there is no difference, in long-term follow-up, in the total number of hospital days or cost for the management of CBDS or GP based on admitting team practices.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Collins C, Maguire D, Ireland A, Fitzgerald E, O’Sullivan GC. A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg 2004;239:28–33. doi:10.1097/01.sla.0000103069.00170.9c.

    Article  PubMed  Google Scholar 

  2. Rijna H, Kemps WG, Eijsbouts Q, Meuwissen SG, Cuesta MA. Preoperative ERCP approach to common bile duct stones: results of a selective policy. Dig Surg 2000;17:229–233. doi:10.1159/000018840.

    Article  PubMed  CAS  Google Scholar 

  3. Hoyuela C, Cugat E, Bretcha P, Collera P, Espinos J, Marco C. Must ERCP Be routinely performed if choledocholithiasis is suspected? Dig Surg 1999;16:411–414. doi:10.1159/000018757.

    Article  PubMed  CAS  Google Scholar 

  4. Fiore NF, Ledniczky G, Wiebke EA, Broadie TA, Pruitt AL, Goulet RJ, et al. An analysis of perioperative cholangiography in one thousand laparoscopic cholecystectomies. Surgery 1997;122:817–821. doi:10.1016/S0039-6060(97)90092-1.

    Article  PubMed  CAS  Google Scholar 

  5. Patel AP, Lokey JS, Harris JB, Sticca RP, McGill ES, Arrillaga A, et al. Current management of common bile duct stones in a teaching community hospital. Am Surg 2003;69:555–560.

    PubMed  Google Scholar 

  6. Petelin JB. Laparoscopic common bile duct exploration. Surg Endosc 2003;17:1705–1715. doi:10.1007/s00464-002-8917-4.

    Article  PubMed  CAS  Google Scholar 

  7. Cuschieri A, Croce E, Faggioni A, Jakimowicz J, Lacy A, Lezoche E, et al. EAES ductal stone study. Preliminary findings of multi-center prospective randomized trial comparing two-stage vs single-stage management. Surg Endosc 1996;10:1130–1135. doi:10.1007/s004649900262.

    Article  PubMed  CAS  Google Scholar 

  8. Cuschieri A, Lezoche E, Morino M, Croce E, Lacy A, Toouli J, et al. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc 1999;13:952–957. doi:10.1007/s004649901145.

    Article  PubMed  CAS  Google Scholar 

  9. Stain SC, Cohen H, Tsuishoysha M, Donovan AJ. Choledocholithiasis. Endoscopic sphincterotomy or common bile duct exploration. Ann Surg 1991;213:627–633.

    Article  PubMed  CAS  Google Scholar 

  10. Hammarstrom LE, Holmin T, Stridbeck H, Ihse I. Long-term follow-up of a prospective randomized study of endoscopic versus surgical treatment of bile duct calculi in patients with gallbladder in situ. Br J Surg 1995;82:1516–1521. doi:10.1002/bjs.1800821121.

    Article  PubMed  CAS  Google Scholar 

  11. Suc B, Escat J, Cherqui D, Fourtanier G, Hay JM, Fingerhut A, et al. Surgery vs endoscopy as primary treatment in symptomatic patients with suspected common bile duct stones: a multicenter randomized trial. French Associations for Surgical Research. Arch Surg 1998;133:702–708. doi:10.1001/archsurg.133.7.702.

    Article  PubMed  CAS  Google Scholar 

  12. Neoptolemos JP, Carr-Locke DL, Fraser I, Fossard DP. The management of common bile duct calculi by endoscopic sphincterotomy in patients with gallbladders in situ. Br J Surg 1984;71:69–71. doi:10.1002/bjs.1800710123.

    Article  PubMed  CAS  Google Scholar 

  13. Winslet MC, Neoptolemos JP. The place of endoscopy in the management of gallstones. Baillieres Clin Gastroenterol 1991;5:99–129. doi:10.1016/0950-3528(91)90008-O.

    Article  PubMed  CAS  Google Scholar 

  14. Bonatsos G, Leandros E, Polydorou A, Romanos A, Dourakis N, Birbas C, et al. ERCP in association with laparoscopic cholecystectomy. A strategy to minimize the number of unnecessary ERCPs. Surg Endosc 1996;10:37–40. doi:10.1007/s004649910009.

    Article  PubMed  CAS  Google Scholar 

  15. Clayton ES, Connor S, Alexakis N, Leandros E. Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ. Br J Surg 2006;93:1185–1191. doi:10.1002/bjs.5568.

    Article  PubMed  CAS  Google Scholar 

  16. Graham SM, Flowers JL, Scott TR, Bailey RW, Scovill WA, Zucker KA, et al. Laparoscopic cholecystectomy and common bile duct stones. The utility of planned perioperative endoscopic retrograde cholangiography and sphincterotomy: experience with 63 patients. Ann Surg 1993;218:61–67. doi:10.1097/00000658-199307000-00010.

    Article  PubMed  CAS  Google Scholar 

  17. Bergman JJ, van der Mey S, Rauws EA, Tijssen JG, Gouma DJ, Tytgat GN, et al. Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age. Gastrointest Endosc 1996;44:643–649. doi:10.1016/S0016-5107(96)70045-7.

    Article  PubMed  CAS  Google Scholar 

  18. Prat F, Malak NA, Pelletier G, Buffet C, Fritsch J, Choury AD, et al. Biliary symptoms and complications more than 8 years after endoscopic sphincterotomy for choledocholithiasis. Gastroenterology 1996;110:894–899. doi:10.1053/gast.1996.v110.pm8608900.

    Article  PubMed  CAS  Google Scholar 

  19. Sugiyama M, Atomi Y. Follow-up of more than 10 years after endoscopic sphincterotomy for choledocholithiasis in young patients. Br J Surg 1998;85:917–921. doi:10.1046/j.1365-2168.1998.00750.x.

    Article  PubMed  CAS  Google Scholar 

  20. Tanaka M, Takahata S, Konomi H, Matsunaga H, Yokohata K, Takeda T, et al. Long-term consequence of endoscopic sphincterotomy for bile duct stones. Gastrointest Endosc 1998;48:465–469. doi:10.1016/S0016-5107(98)70086-0.

    Article  PubMed  CAS  Google Scholar 

  21. Jacobsen O, Matzen P. Long-term follow-up study of patients after endoscopic sphincterotomy for choledocholithiasis. Scand J Gastroenterol 1987;22:903–906. doi:10.3109/00365528708991933.

    Article  PubMed  CAS  Google Scholar 

  22. Sugiyama M, Atomi Y. Risk factors predictive of late complications after endoscopic sphincterotomy for bile duct stones: long-term (more than 10 years) follow-up study. Am J Gastroenterol 2002;97:2763–2767. doi:10.1111/j.1572-0241.2002.07019.x.

    Article  PubMed  Google Scholar 

  23. Sugiyama M, Suzuki Y, Abe N, Masaki T, Mori T, Atomi Y. Endoscopic retreatment of recurrent choledocholithiasis after sphincterotomy. Gut 2004;53:1856–1859. doi:10.1136/gut.2004.041020.

    Article  PubMed  CAS  Google Scholar 

  24. Basso N, Pizzuto G, Surgo D, Materia A, Silecchia G, Fantini A, et al. Laparoscopic cholecystectomy and intraoperative endoscopic sphincterotomy in the treatment of cholecysto-choledocholithiasis. Gastrointest Endosc 1999;50:532–535. doi:10.1016/S0016-5107(99)70078-7.

    Article  PubMed  CAS  Google Scholar 

  25. Tai CK, Tang CN, Ha JP, Chau CH, Siu WT, Li MK. Laparoscopic exploration of common bile duct in difficult choledocholithiasis. Surg Endosc 2004;18:910–914. doi:10.1007/s00464-003-8216-8.

    Article  PubMed  CAS  Google Scholar 

  26. Poulose BK, Arbogast PG, Holzman MD. National analysis of in-hospital resource utilization in choledocholithiasis management using propensity scores. Surg Endosc 2006;20:186–190. doi:10.1007/s00464-005-0235-1.

    Article  PubMed  CAS  Google Scholar 

  27. Liberman MA, Phillips EH, Carroll BJ, Fallas MJ, Rosenthal R, Hiatt J. Cost-effective management of complicated choledocholithiasis: laparoscopic transcystic duct exploration or endoscopic sphincterotomy. J Am Coll Surg 1996;182:488–494.

    PubMed  CAS  Google Scholar 

  28. Urbach DR, Khajanchee YS, Jobe BA, Standage BA, Hansen PD, Swanstrom LL. Cost-effective management of common bile duct stones: a decision analysis of the use of endoscopic retrograde cholangiopancreatography (ERCP), intraoperative cholangiography, and laparoscopic bile duct exploration. Surg Endosc 2001;15:4–13. doi:10.1007/s004640000322.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Kyle Brooks and Stuart Schulman for assistance with database development. There are no sources of support to be reported.

Author information

Authors and Affiliations

  1. Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Jennifer LaFemina, Deborah McGrath & David L. Berger

  2. Decision Support and Quality Management Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Suzanne M. Sokal

  3. Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Yuchiao Chang

  4. Massachusetts General Hospital, 15 Parkman Street, WAC 4-460, Boston, MA, 02114, USA

    David L. Berger

Authors
  1. Jennifer LaFemina
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Suzanne M. Sokal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuchiao Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Deborah McGrath
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David L. Berger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David L. Berger.

Additional information

This manuscript is not based on communication to a society or meeting.

Rights and permissions

Reprints and permissions

About this article

Cite this article

LaFemina, J., Sokal, S.M., Chang, Y. et al. Effect of Medical or Surgical Admission on Outcome of Patients with Gallstone Pancreatitis and Common Bile Duct Stones. J Gastrointest Surg 12, 1554–1560 (2008). https://doi.org/10.1007/s11605-008-0580-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-008-0580-1

Keywords

Search

Navigation