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Index Admission Cholecystectomy for Acute Biliary Pancreatitis Favorably Impacts Outcomes of Hospitalization in Cirrhosis.
J Gastroenterol Hepatol. 2019 Jul 01;:
Authors: Patel K, Mumtaz K, Li F, Luthra A, Hinton A, Lara LF, Conwell DL, Krishna SG
Abstract
BACKGROUND AND AIM: Despite higher rates of gallstones in patients with cirrhosis, there are no population-based studies evaluating outcomes of acute biliary pancreatitis (ABP). Therefore, we sought to evaluate the predictors of early readmission and mortality in this high-risk population.
METHODS: We utilized the Nationwide Readmission Database (2011-2014) to evaluate all adults admitted with ABP. Multivariable logistic regression models were used to assess independent predictors for 30-day readmission, index admission mortality, and calendar year mortality.
RESULTS: Among 184,611 index-admissions with ABP, 4,344 (2.4%) subjects had cirrhosis (1,649 with decompensation). Subjects with cirrhosis, when compared to those without, incurred higher rates of 30-day readmission (20.9% vs. 11.2%; p<0.001), index mortality (2.0% vs. 1.0%; p<0.001), and calendar year mortality (4.2% vs. 0.9%; p<0.001). Decompensation in cirrhosis was associated with significantly fewer cholecystectomies (26.7% vs 60.2%; p < 0.001) and ERCPs (23.3% vs 29.9%; p < 0.001). Multivariate analysis revealed that severe acute pancreatitis (OR: 14.8; 95% CI: 5.3-41.2), sepsis (OR: 12.6; 95% CI: 5.8-27.4), and decompensation (OR: 3.1; 96% CI: 1.4-6.6) were associated with increased index-admission mortality. Decompensated cirrhosis (OR: 1.8; 95% CI: 1.1-3.0) and 30-day readmission (OR: 5.6; 95% CI: 3.3-9.5) were predictors of calendar-year mortality. However, index-admission cholecystectomy was associated with decreased 30-day readmissions (OR: 0.6; 95% CI: 0.4-0.7) and calendar-year mortality (OR: 0.44; 95% CI 0.25-0.78).
CONCLUSIONS: Presence of cirrhosis adversely impacts hospital outcomes of patients with ABP. Among modifiable factors, index-admission cholecystectomy portends favorable prognosis by reducing risk of early readmission and consequent calendar-year mortality.
PMID: 31264249 [PubMed - as supplied by publisher]