Early cholecystectomy and ERCP are associated with reduced readmissions for acute biliary pancreatitis: a nationwide, population-based study

• Published in: Gastrointestinal endoscopy Vol. 75; no. 1; pp. 47 - 55
• Main Authors: Nguyen, Geoffrey C., MD, PhD, Rosenberg, Morgan, MD, Chong, Rachel Y., MD, PhD, Chong, Christopher A., MD
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 2012; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Canada; Cholangiopancreatography, Endoscopic Retrograde - utilization; Cholecystectomy - utilization; Digestive system; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Guidelines as Topic; Hospitals - statistics & numerical data; Humans; Investigative techniques, diagnostic techniques (general aspects); Kaplan-Meier Estimate; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Logistic Models; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Outcome Assessment (Health Care) - statistics & numerical data; Pancreatitis - surgery; Patient Readmission - statistics & numerical data; Proportional Hazards Models; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Secondary Prevention; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Time Factors; Canada; OR; acute biliary pancreatitis; CI; hazard ratio; confidence interval; HR; odds ratio; ABP; Cholecystectomy; Biliary tract; Cholangiopancreatography; Radiodiagnosis; Acute; Pancreatitis; Treatment; Surgery; Gastroenterology; Digestive diseases; Gallbladder; Endoscopy; Pancreatic disease
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2011.08.028

Background Cholecystectomy is recommended during hospitalizations for acute biliary pancreatitis (ABP). Objective We sought to assess the population-based effectiveness of index cholecystectomy by using nationwide data. Design Retrospective, cohort study. Setting All acute-care hospitals in Canada from 2007 to 2010. Patients This study involved patients admitted for ABP in the Canadian Institutes for Health Information hospital discharge database. Intervention Cholecystectomy and therapeutic ERCP during the index admission. Main Outcome Measurements Rate of hospital readmissions for ABP. Results Among 5646 patients with ABP, 32% underwent cholecystectomy and 22% ERCP during the index admissions. Patients admitted to hospitals in the highest quartile for cholecystectomy volume were more than 10-fold likely to undergo cholecystectomy during the index admission (adjusted odds ratio 11.0; 95% confidence interval [CI], 7.4-16.5). The 12-month readmission rate for ABP was lower with cholecystectomy (5.6% vs 14.0%; P < .0001) and therapeutic ERCP (5.1% vs 13.1%; P < .0001). After multivariate adjustment, lower readmission rates were independently associated with both cholecystectomy (adjusted hazard ratio [HR] 0.39; 95% CI, 0.32-0.48) and ERCP (adjusted HR 0.37; 95% CI, 0.29-0.50). After excluding early readmissions (within 28 days of discharge), the adjusted HR for cholecystectomy was 0.43 (95% CI, 0.34-0.57). The admitting hospital's cholecystectomy volume was inversely associated with 12-month readmission rates for ABP (quartile 1, 15.9%; quartile 2, 13.9%; quartile 3, 11.3%; quartile 4, 10.0%; P < .001). Limitations The study was based on hospital administrative data. Conclusion Cholecystectomy and ERCP during the index admission were associated with reduced readmission rates for ABP, providing population-based evidence to support consensus guidelines that recommend early biliary intervention.