A. E. Hozain1,2, P. J. Chung1,2, M. C. Smith1,2, V. Roudnitsky2, A. E. Alfonso1, G. Sugiyama1 1State University Of New York Downstate Medical Center,Department Of Surgery,Brooklyn, NY, USA 2Kings County Hospital Center,Department Of Surgery,Brooklyn, NY, USA
Introduction:
With over 200,000 cases per year, acute cholecystitis is one of the most frequent causes for admission to hospitals and management by general surgeons. Percutaneous cholecystostomy is an increasingly used treatment for patients diagnosed with acute cholecystitis, who are otherwise too ill to undergo cholecystectomy. Given these patients’ significant comorbidities, a retrospective analysis to determine predictors of mortality was performed using the Nationwide Inpatient Sample (NIS).
Methods:
The Nationwide Inpatient Sample (NIS) from 2005 – 2012 was sampled. Inclusion criteria included patients with a diagnosis of acute cholecystitis by ICD 9 code (574.0, 574.00, 574.01, 575.0, 575.12) who underwent percutaneous cholecystostomy (51.01). We excluded patients with a diagnosis of acalculous cholecystitis (575.10), patients age < 18 years, and cases where gender, race, weekend admission, and month of admission data were missing. For each case, we computed the Elixhauser-Van Walraven score for comorbidity status. Multiple imputation was performed for missing data. We then performed multivariable logistic regression analysis with inpatient mortality as the primary outcome variable. Age, gender, race, insurance status, income status, hospital size, hospital type, geographical region, weekend admission, month of admission, and Elixhauser-Van Walraven score were used as risk variables.?
Results:
8,299 patients were included in this study. 785 (9.46%) patients died during the hospital admission. After adjusting for the risk variables, predictors for inpatient mortality included age (OR 1.16 [1.00 – 1.34 95% CI], p = 0.0492), receiving care in an urban non-teaching hospital (OR 1.27 [1.08 – 1.50 95% CI], p = 0.0169), female gender (OR 1.30 [1.12 – 1.52 95% CI], p = 0.0006), and the Elixhauser-Van Walraven score (OR 2.13 [1.93 – 2.36 95% CI], p < 0.0001). There was a decreased risk of death for patients receiving care in the Midwest (OR 0.74 [0.59 – 0.94 95% CI], p = 0.0357) and West (0.78 [0.63 – 0.98 95% CI], p = 0.0357) compared to the Northeast.
Conclusion:
Adjusting for multiple variables, receiving treatment within the Midwest and Western regions of the United States was independently associated with a decreased risk of mortality in patients undergoing percutaneous cholecystostomy. Risk factors associated with increased mortality include age, female gender, Elixhauser-Van Walraven comorbidity score and urban, non-teaching hospitals. To improve outcomes nationally, models looking at practice differences between regions may further elucidate significant differences in quality or process of care.