M. Fleming1, Y. Zhang2,3, F. Liu2,4, J. Luo2, K. Y. Pei1 1Yale University School Of Medicine,Department Of Surgery,New Haven, CT, USA 2Yale University School Of Medicine,Section Of Surgical Outcomes And Epidemiology, Department Of Surgery,New Haven, CT, USA 3Yale School Of Public Health,Department Of Environmental Health Services,New Haven, CT, USA 4Beijing 302 Hospital,Beijing, FENGTAI QU, China
Introduction:
High risk patients undergoing cholecystectomy may experience increased morbidity and mortality. Consequently, percutaneous cholecystostomy (PC) has been utilized as a treatment option for acute cholecystitis in this cohort of patients. Little is known about incidence of and predictive risk factors for readmission following PC; therefore, we sought to determine predictors of readmission after PC.
Methods:
Patients who had PC from 2013-2014 were identified from the National Readmission Database (NRD) by the Healthcare Cost and Utilization Project (HCUP). A 30-day readmission was defined as a subsequent admission within 30 days following the first admission discharge date. Multivariate logistic regression models using stepwise selection were employed to select significant predictive variables.
Results:
A total of 3,368 patients were identified with 698 (20.7%) readmissions during the study period. Severity of illness directly correlated with readmission risk at 30 days (moderate loss of function OR 1.60 95% CI 1.11 – 2.30, major loss of function OR 1.76 CI 1.23 – 2.52, extreme loss of function OR 2.37 CI 1.62 – 3.46). Additionally, alcohol use (OR 1.45 CI 1.02 – 2.07), congestive heart failure (CHF, OR 1.26 CI 1.01 – 1.57), depression (CI 1.42 OR 1.08 – 1.86), metastatic cancer (OR 1.56 CI 1.05 – 2.30) and peripheral vascular disease (OR 0.73 CI 0.54 – 0.99) were closely correlated with risk for readmission at 30 days. Uncomplicated diabetes (P = 0.05), hypertension (P = 0.93), obesity (P = 0.61), and renal failure (P = 0.47) were not correlated with risk for readmission.
Conclusion:
Percutaneous cholecystostomy has become a crucial tool for the acute care of high risk patients with cholecystitis. However, a significant proportion of patients are readmitted within 30 days following discharge. These patients may benefit from increase care coordination services starting at their index admission and increased communication with the clinical team once the patient is discharged. Additional studies are needed to determine optimal timing to interval cholecystectomy.