W. Luo1,2,3, S.V. Shinde3, C. Agala3, P.O. Udekwu1, A. Charles2,3 1WakeMed Health and Hospitals, General Surgery, Raleigh, NC, USA 2University Of North Carolina At Chapel Hill, Division Of Acute Care And General Surgery, Chapel Hill, NC, USA 3University Of North Carolina At Chapel Hill, School Of Medicine, Chapel Hill, NC, USA
Introduction:
Gallstone pancreatitis accounts for 40% of acute pancreatitis diagnosed in the US and has a higher mortality rate than alcohol induced pancreatitis. The current standard of care is same-admission cholecystectomy. Earlier studies have shown that social determinants of health, including race and gender among others, were associated with decreased odds of undergoing cholecystectomy and ERCP during the same admission. We performed an updated analysis of the National Inpatient Sample(NIS) to see whether such disparities persist.
Methods:
We queried the NIS for inpatients diagnosed with gallstone pancreatitis from 2015 through 2019. We excluded patients<18 years old, missing race/ethnicity data, missing mortality data, and/or transferred to another hospital or discharged against medical advice. We then performed a multivariable logistic regression with cholecystectomy and mortality as our primary and secondary outcomes of interest. Our exposure of interest was race/ethnicity. The following covariates were entered into our model a priori: age, Elixhauser readmission and mortality indices, hospital type, region, and payor status.
Results:After applying our exclusions, we found 54,843 patients admitted with gallstone pancreatitis from 2015 to 2019. Median age was 60 years, 62% of patients received same-admission cholecystectomy, and 9.2% of our cohort identified as non-Hispanic Black. After adjustment for covariates, non-Hispanic Black patients were less likely than non-Hispanic White patients to undergo same-admission cholecystectomy (OR 0.80, 95% CI 0.75-0.86, p<0.001) and more likely to die (OR 1.28, 95% CI 1.01-1.62, p=0.04). Patients who died in our cohort regardless of race/ethnicity were also less likely to have undergone a cholecystectomy(OR 0.12, 95% CI 0.010-0.15, p<0.001).
Conclusion:
Our results demonstrate a persistent racial disparity in receiving the standard of care for gallstone pancreatitis in the US. Non-Hispanic Black patients with gallstone pancreatitis are almost 20% less likely to receive same-admission cholecystectomy compared to their White counterparts. They are nearly 30% more likely to die during that index admission. Moreover, our results continue to support cholecystectomy before discharge. This worrisome trend represents a failure to provide equitable access to the standard management for this disease process in the US.