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Early unplanned readmissions following same-admission cholecystectomy for acute biliary pancreatitis
Brandon K Chu1, Bipul Gnyawali2, Jordan M Cloyd3
1Department of Internal Medicine, The Ohio State University Wexner Medical Center, The Ohio State University College of Medicine, Columbus, OH, USA.
Insights
Same-admission cholecystectomy for mild acute biliary pancreatitis has a 7.25% readmission rate. Key readmission factors include prior conditions, pancreatitis sequelae, and complications, while intraoperative cholangiogram and ERCP reduce readmission risk.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Outcomes Research
- Health Services Research
Background:
- Same-admission cholecystectomy (CCY) is standard for mild acute biliary pancreatitis (biliary-AP).
- Early (30-day) unplanned readmissions post-CCY for biliary-AP are not well-studied.
- Investigating readmission predictors is crucial for improving patient care.
Purpose of the Study:
- To identify predictors and causes of 30-day readmissions in patients undergoing CCY for biliary-AP.
- To analyze the impact of invasive cholangiography on readmission rates.
- To inform strategies for reducing early hospital readmissions.
Main Methods:
- Analysis of the Nationwide Readmission Database (2010-2014).
- Inclusion of adult patients with biliary-AP undergoing same-admission CCY.
- Multivariable logistic regression to determine readmission predictors.
Main Results:
- A total of 118,224 patients underwent CCY for biliary-AP.
- The 30-day readmission rate was 7.25%, driven by prior condition exacerbations, biliary-AP sequelae, and surgical complications.
- Male sex, specific insurance types, outside-facility discharge, severe AP, and comorbidities increased readmission risk.
- Intraoperative cholangiogram (IOC) and ERCP were associated with decreased readmission risk.
Conclusions:
- Identified modifiable risk factors and causes for early readmission after CCY for biliary-AP.
- Findings highlight opportunities to enhance clinical management and reduce readmission rates.
- Routine use of IOC and ERCP may play a role in preventing early readmissions.
Background:
Same-admission cholecystectomy (CCY) is recommended for mild acute biliary pancreatitis (biliary-AP). However, there is a paucity of research investigating reasons for early (30-day) unplanned readmissions in patients who undergo CCY for biliary-AP. Hence, we sought to investigate this gap using a large population database.
Methods:
Using the Nationwide Readmission Database (2010-2014), we identified all adults (age ≥ 18 years) with a principal diagnosis of biliary-AP who had undergone CCY during the index hospitalization. Multivariable logistic regression models were obtained to assess independent predictors for 30-day readmission. Principal diagnosis for all readmissions was collected to ascertain the indications for early readmission.
Results:
During the study period, 118,224 patients underwent same-admission CCY for biliary-AP. Three-fourths of all patients underwent invasive cholangiography during the hospitalization (intraoperative cholangiogram (IOC) = 57,038, ERCP = 31,500). The rate of early (30-day) readmission was 7.25% (n = 8574). Exacerbation of prior medical conditions (42.2%), sequelae of biliary-AP (resolving and recurrent pancreatitis, pseudocysts) (27.6%), surgical site and other postoperative complications (16%), choledocholithiasis and/or bile leak (9.6%), and preventable hospital-acquired conditions (4.6%) accounted for early readmissions. On multivariable analysis, predictors for readmission included male sex (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.08-1.28), insurance type (Medicare insurance [OR 1.26, 95% CI 1.13-1.40]; Medicaid [OR 1.22, 95% CI 1.09-1.38]), outside-facility discharge (OR 1.35, 95% CI 1.16-1.57), severe AP (OR 1.35, 95% CI 1.21-1.50), and ≥ 3 Elixhauser comorbidities (OR 1.55, 95% CI 1.41-1.69). Performance of IOC (OR 0.90, 95% CI 0.82-0.97) and ERCP (OR 0.81, 95% CI 0.73-0.89) were associated with decreased risk of early readmission.
Conclusion:
In this study, using a national population database evaluating patients who underwent same-admission CCY after biliary-AP, we identified potentially modifiable risk factors and causes for early readmission as well as opportunities to improve clinical care.
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