Effects of socioeconomics on biliary disease in patients with sickle cell

There are approximately 100,000 patients with sickle cell disease (SCD) in America with 134,000 SCD-related admissions annually costing $1.1 billion. Cholecystectomy is the most common procedure in those patients. We evaluate the impact of socioeconomic factors on peri-operative outcomes.

The Nationwide Inpatient Sample was queried for patients with SCD and gallbladder disease between 2006 and 2015. Patients were stratified by insurance and hospital type. Outcomes included perioperative vaso-occlusive crisis (VOC), post-operative morbidity, and mortality.

A total of 1779 patients were included. Most patients had Medicaid (49 ​%), then Private insurance (29 ​%). Urban-Teaching hospitals cared for 75 ​% of patients. Complications were lowest with private insurance. On logistic regression, odds of VOC were 1.57 [1.05-2.33] with Medicare and 1.51 [1.13-2.01] with Medicaid.

Majority of patients with SCD undergoing cholecystectomy have Medicaid and receive care in urban teaching hospitals. Perioperative VOC was lowest with private insurance and significantly higher with Medicare and Medicaid.