Trends in same-admission cholecystectomy and endoscopic retrograde cholangiopancreatography for acute gallstone pancreatitis: A nationwide analysis across a decade

• Published in: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] Vol. 19; no. 4; pp. 524 - 530
• Main Authors: Bilal, Mohammad, Kline, Kevin T., Trieu, Judy A, Saraireh, Hamzeh, Desai, Madhav, Parupudi, Sreeram, Abougergi, Marwan S.
• Format: Journal Article
• Language: English
• Published: Switzerland Elsevier B.V 01.06.2019; Elsevier Limited
• Subjects: Acute pancreatitis; Age; Biliary pancreatitis; Calculi; Cholangiopancreatography, Endoscopic Retrograde - statistics & numerical data; Cholangiopancreatography, Endoscopic Retrograde - trends; Cholangitis; Cholecystectomy; Cholecystectomy - statistics & numerical data; Cholecystectomy - trends; Confidence intervals; Databases, Factual; Diagnosis; Endoscopy; ERCP; Female; Gallstone pancreatitis; Gallstones; Gallstones - epidemiology; Gallstones - etiology; Gallstones - therapy; Gastroenterology; Guideline Adherence; Hospital Costs; Hospitalization; Humans; Length of Stay; Male; Medicaid; Medicare; Middle Aged; Pacific Islander people; Pancreatitis; Pancreatitis - complications; Pancreatitis - epidemiology; Pancreatitis - therapy; Patient Admission - statistics & numerical data; Patients; Postal codes; Retrospective Studies; Treatment Outcome; Trends; United States - epidemiology; Variables; United States; United States > US; Cholecystectomy; Biliary pancreatitis; ERCP; Acute pancreatitis; Gallstone pancreatitis
• ISSN: 1424-3903; 1424-3911
• DOI: 10.1016/j.pan.2019.04.008

Gallstones are the leading cause of acute pancreatitis in developed countries. National and international guidelines recommend that a cholecystectomy should be performed during the index hospitalization for acute gallstone pancreatitis. We aimed to delineate the national trends for same-admission cholecystectomy and ERCP for acute gallstone pancreatitis over the last ten years. We used the 2004, 2009 and 2014 National Inpatient Sample database including patients with a principal diagnosis of acute pancreatitis and a secondary diagnosis of choledocholithiasis or cholelithiasis. Exclusion criteria were age <18 years and elective admission. Primary outcome was the trend in incidence rate of same admission cholecystectomy from 2004 to 2014. The secondary outcomes were: 10-year trend in 1) Incidence of gallstone pancreatitis, 2) proportion of gallstone pancreatitis compared to all other etiologies of acute pancreatitis, 3) incidence rate of same-admission ERCP, 4) length of hospital stay, and 5) total hospitalization costs and charges. The proportion of admissions during which a same-admission cholecystectomy was performed decreased from 48.7% in 2004 to 46.9% in 2009 to 45% in 2014 (trend p < 0.01). During the same time interval, the percentage of admissions during which an ERCP was performed decreased from 25.1% to 18.7% (Trend p < 0.01). Adherence to the guidelines for same-admission cholecystectomy for patients admitted with acute gallstone pancreatitis have been declining over the past decade. On the other hand, decline in rate of ERCP in patients with acute gallstone pancreatitis and no signs of cholangitis demonstrates adherence to guidelines in this regard.