Journal
JOURNAL OF GASTROINTESTINAL SURGERY
Volume 25, Issue 4, Pages 880-886Publisher
SPRINGER
DOI: 10.1007/s11605-021-04959-6
Keywords
Acute cholecystitis; Cholecystectomy; Percutaneous cholecystostomy; Healthcare disparities; Health outcomes
Categories
Funding
- NIH [T32 DK007533-35]
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The study found that in the treatment of acute cholecystitis, patients receiving PC were mostly in urban teaching hospitals, with longer lengths of stay, higher hospital costs, and higher mortality rates. Multiple socioeconomic and healthcare related factors influence the utilization of PC, including gender, race/ethnicity, payer status, hospital location, and household income.
Background While percutaneous cholecystostomy (PC) is a recommended treatment strategy in lieu of cholecystectomy (CCY) for acute cholecystitis among patients who may not be considered good surgical candidates, reports on disparities in treatment utilization remain limited. The aim of this study was to investigate the role of demographic, clinical, and socioeconomic factors in treatment of acute cholecystitis. Methods Patients with a diagnosis of acute cholecystitis who underwent CCY versus PC were reviewed from the U.S. Nationwide Inpatient Sample (NIS) database between 2008-2014. Measured variables including age, race/ethnicity, Charlson comorbidity index (CCI), hospital type/region, insurance payer, household income, length of stay (LOS), hospital cost, and mortality were compared using chi-square and ANOVA. Multivariable logistic regression was performed to identify specific predictors of cholecystitis treatment. Results A total of 1,492,877 patients (CCY:n=1,435,255 versus PC:n=57,622) were analyzed. The majority of patients that received PC were at urban teaching hospitals (65.2%). LOS was significantly longer with higher associated costs for PC [(11.1 +/- 11.0 versus 4.5 +/- 5.3 days; P<0.001) and ($99577 +/- 138850 versus $48399 +/- 58330; P<0.001)]. Mortality was also increased for patients that received PC compared to CCY (8.8% versus 0.6%; P<0.001). Multivariable regression demonstrated multiple socioeconomic and healthcare-related factors influencing the utilization of PC including male gender, Black or Asian race/ethnicity, Medicare payer status, urban hospital location, and household income (all P<0.001). Conclusion Although patients receiving PC had higher CCI scores, multiple socioeconomic and healthcare related factors appeared to also influence this treatment decision. Additional studies to investigate these disparities are indicated to improve outcomes for all individuals with this condition.
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