Journal Article

Effectiveness of Guideline-Recommended Cholecystectomy to Prevent Recurrent Pancreatitis

Akhuemonkhan, Eboselume, Kamal, Ayesha, Akshintala, Venkata S, Singh, Vikesh K, Hutfless, Susan M, Kalloo, Anthony N

2017

Overview

Cholecystectomy during or within 4 weeks of hospitalization for acute biliary pancreatitis is recommended by guidelines. We examined adherence to the guidelines for incident mild-to-moderate acute biliary pancreatitis and the effectiveness of cholecystectomy to prevent recurrent episodes of pancreatitis. Individuals in the 2010-2013 MarketScan Commercial Claims & Encounters database with a hospitalization associated with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes of 577.0 for acute pancreatitis and 574.x for gallstone disease were eligible. Guideline adherence was considered cholecystectomy within 30 days of the first/index hospitalization for biliary pancreatitis. Individuals with and without guideline-adherent cholecystectomy were compared for subsequent hospitalization for acute or chronic pancreatitis using a Cox proportional hazards model adjusted for age, sex, comorbidities, and length of index hospital stay. Of the 17,010 patients who met the inclusion criteria, 78% were adherent with the guidelines, including 10,918 who underwent cholecystectomy during the index hospitalization and 2,387 who underwent cholecystectomy within 30 days. Among 3,705 patients non-adherent with the guidelines, 1,213 had a cholecystectomy 1-6 months after the index hospitalization. Guideline-adherent cholecystectomy resulted in fewer subsequent hospitalizations for acute and chronic pancreatitis as compared with non-adherence to the guidelines (acute pancreatitis: 3% vs. 13%, P<0.001; chronic pancreatitis: 1% vs. 4%, P<0.001). Nearly four out of five patients underwent cholecystectomy for acute biliary pancreatitis in a timeframe, consistent with guidelines. Adherence resulted in a decrease in subsequent hospitalizations for both acute and chronic pancreatitis. However, the majority of non-adherent patients did not undergo a subsequent cholecystectomy. There may be factors that predict the need for immediate vs. delayed cholecystectomy.

• Publisher: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subject: Acute Disease / Adolescent / Adult / Cholecystectomy - methods / Cohort Studies / Comorbidity / Female / Gallstones - complications / Gallstones - surgery / Gastroenterology / Guideline Adherence / Humans / Length of Stay / Male / Middle Aged / Pancreatitis - etiology / Pancreatitis - prevention & control / Pancreatitis, Chronic - etiology / Pancreatitis, Chronic - prevention & control / Practice Guidelines as Topic / Proportional Hazards Models / Recurrence / Retrospective Studies / Secondary Prevention - methods / Severity of Illness Index / Young Adult