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Index admission cholecystectomy for acute cholecystitis reduces 30-day readmission rates in pediatric patients
Sagar J Pathak1, Hyun Ji2, Amar Nijagal3,4,5,6
1Division of Pediatric Gastroenterology, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA. sagar.j.pathak@gmail.com.
Insights
Pediatric patients with acute cholecystitis not undergoing surgery during their initial hospital stay had a tenfold higher risk of 30-day readmission. This highlights the importance of timely cholecystectomy for better outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Health Outcomes Research
Background:
- Adult data suggests worse outcomes for cholecystitis patients not undergoing surgery during index admission.
- Limited data exists on the impact of index cholecystectomy in pediatric acute cholecystitis.
- This study addresses the knowledge gap in pediatric cholecystitis management.
Purpose of the Study:
- To compare outcomes and readmission rates in pediatric patients with acute cholecystitis.
- To evaluate the impact of undergoing cholecystectomy during the index hospitalization versus not.
- To identify factors influencing 30-day readmissions in this population.
Main Methods:
- Retrospective study using the 2018 National Readmission Database.
- Included pediatric patients (<18 years) hospitalized with acute cholecystitis.
- Multivariable logistic regression analyzed factors associated with 30-day readmissions.
Main Results:
- 550 pediatric acute cholecystitis admissions were analyzed.
- Index cholecystectomy was performed in 79.1% of cases.
- 30-day readmission rates were significantly higher for those not undergoing index cholecystectomy (22.6% vs. 2.8%, p<0.001).
- Patients not undergoing index cholecystectomy had 10.66 times higher odds of readmission (p<0.001).
- Female patients also had higher odds of readmission (OR 3.37).
Conclusions:
- Omitting index cholecystectomy in pediatric acute cholecystitis is associated with a >10-fold increase in 30-day readmission odds.
- Further research is needed to understand barriers to index cholecystectomy.
- Timely surgical intervention appears crucial for improved pediatric cholecystitis outcomes.
Background:
Adult patients with cholecystitis who do not undergo cholecystectomy on index admission have worse outcomes, however, there is a paucity of data of the role of cholecystectomy during index hospitalization in the pediatric population. Our aim was to determine outcomes and readmission rates among pediatric patients with cholecystitis who underwent index cholecystectomy versus those who did not.
Methods:
We performed a retrospective study of pediatric (< 18 years old) admitted with acute cholecystitis (AC) requiring hospitalization using the 2018 National Readmission Database (NRD). Exclusion criteria included age ≥ 18 years and death on index admission. Multivariable logistic regression was performed to identify factors associated with 30-day readmissions.
Results:
We identified 550 unique index acute cholecystitis admissions. Mean age was 14.6 ± 3.0 years. Majority of patients were female (n = 372, 67.6%). Index cholecystectomy was performed in (n = 435, 79.1%) of cases. Thirty-day readmission rate was 2.8% in patients who underwent index cholecystectomy and 22.6% in those who did not (p < 0.001). On multivariable analysis, patients who did not undergo index cholecystectomy had higher odds of 30-day readmission than those who did not (OR 10.66, 95% CI 5.06-22.45, p < 0.001). Female patients also had higher odds of 30-day readmission compared to males (OR 3.37, 95% CI 1.31-8.69).
Conclusions:
Patients who did not undergo index cholecystectomy had over tenfold increase in odds of 30-day readmission. Further research is required to understand the barriers to index cholecystectomy despite society recommendations and clear clinical benefit.
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