Format

Send to:

Choose Destination
See comment in PubMed Commons below
Gastrointest Endosc. 2012 Jan;75(1):47-55. doi: 10.1016/j.gie.2011.08.028. Epub 2011 Nov 17.

Early cholecystectomy and ERCP are associated with reduced readmissions for acute biliary pancreatitis: a nationwide, population-based study.

Author information

  • 1Mount Sinai Hospital, Division of Gastroenterology, Toronto, Ontario, Canada.

Abstract

BACKGROUND:

Cholecystectomy is recommended during hospitalizations for acute biliary pancreatitis (ABP).

OBJECTIVE:

We sought to assess the population-based effectiveness of index cholecystectomy by using nationwide data.

DESIGN:

Retrospective, cohort study.

SETTING:

All acute-care hospitals in Canada from 2007 to 2010.

PATIENTS:

This study involved patients admitted for ABP in the Canadian Institutes for Health Information hospital discharge database.

INTERVENTION:

Cholecystectomy and therapeutic ERCP during the index admission.

MAIN OUTCOME MEASUREMENTS:

Rate of hospital readmissions for ABP.

RESULTS:

Among 5646 patients with ABP, 32% underwent cholecystectomy and 22% ERCP during the index admissions. Patients admitted to hospitals in the highest quartile for cholecystectomy volume were more than 10-fold likely to undergo cholecystectomy during the index admission (adjusted odds ratio 11.0; 95% confidence interval [CI], 7.4-16.5). The 12-month readmission rate for ABP was lower with cholecystectomy (5.6% vs 14.0%; P < .0001) and therapeutic ERCP (5.1% vs 13.1%; P < .0001). After multivariate adjustment, lower readmission rates were independently associated with both cholecystectomy (adjusted hazard ratio [HR] 0.39; 95% CI, 0.32-0.48) and ERCP (adjusted HR 0.37; 95% CI, 0.29-0.50). After excluding early readmissions (within 28 days of discharge), the adjusted HR for cholecystectomy was 0.43 (95% CI, 0.34-0.57). The admitting hospital's cholecystectomy volume was inversely associated with 12-month readmission rates for ABP (quartile 1, 15.9%; quartile 2, 13.9%; quartile 3, 11.3%; quartile 4, 10.0%; P < .001).

LIMITATIONS:

The study was based on hospital administrative data.

CONCLUSION:

Cholecystectomy and ERCP during the index admission were associated with reduced readmission rates for ABP, providing population-based evidence to support consensus guidelines that recommend early biliary intervention.

Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

PMID:
22100300
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk