Abstract
Background
The majority of cases of idiopathic acute pancreatitis (IAP) are thought to result
from occult biliary disease. A growing body of evidence suggests that cholecystectomy
for IAP reduces the risk of recurrence by up to two thirds. This study examined nationwide
uptake and disparities in adoption of cholecystectomy for IAP.
Methods
The National Inpatient Sample was queried to identify admissions for IAP between October
2015 and December 2018. Patients who underwent cholecystectomy before discharge and
those that did not were compared using Wald χ2 tests for categorical variables and Student’s t test for continuous variables. Patient- and hospital-level predictors of cholecystectomy
were identified using weighted multivariable logistic regression.
Results
Of 62,305 estimated admissions for IAP, only 665 (1.1%) underwent cholecystectomy
before discharge. Female sex, initiation of total parenteral nutrition (TPN), insurance
status, and hospital type were associated with cholecystectomy on univariable analysis.
On multivariable analysis, Hispanic patients (odds ration [OR] 1.60, 95% confidence
interval [CI] 1.01–2.56), patients on TPN (OR 2.70, 95% CI 1.17–6.24), and those with
private insurance (OR 2.18, 95% CI 1.48–3.21 versus Medicare/Medicaid) were more likely
to receive operations. Small hospitals and hospitals in rural areas were least likely
to perform empiric cholecystectomies.
Conclusion
Despite increasing evidence supporting cholecystectomy after IAP, the practice remains
rare in the United States. Educational efforts and active implementation efforts are
needed to promote adoption. Particular attention should be focused on small, rural
centers and those that disproportionately care for uninsured patients and patients
with public insurance.
Graphical abstract
Graphical Abstract
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Article info
Publication history
Published online: May 11, 2022
Accepted:
April 7,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
