S. S. Satahoo1, C. I. Schulman1, J. E. Sola1, H. L. Neville1 1University Of Miami,Surgery,Miami, FL, USA
Introduction: Historically, cholelithiasis was predominantly seen in patients with hemolytic anemias. However, recent data have shown an association with gallbladder disease and obesity, paralleling national trends. Accordingly, we sought to evaluate the influence of sickle cell disease (SCD) and obesity on cholelithiasis with the hypothesis that obesity would now have a stronger influence on disease development and outcomes.
Methods: The Nationwide Inpatient Sample was queried for patients<18 years from 2005-2009 and ICD-9 codes for cholelithiasis(574-574.91). Demographic data, comorbidities (including SCD and obesity), surgery, charges, length of stay and mortality were recorded. Student’s t-test, Χ2 test and logistic regression were performed, where appropriate. Logistic regression included age, sex, race, SCD and obesity to determine their impact on cholelithiasis. A p-value <0.05 was considered significant.
Results: There were 9,130 unweighted cholelithiasis encounters. The rate of cholelithiasis remained unchanged over the 5 years. In patients with cholelithiasis, the rates of sickle cell disease and obesity were similar overall (10.0% and 11.1% respectively). However, the rates of sickle cell disease decreased over time (2005: 12.5%, 2006: 8.8%, 2007: 10.7%, 2008: 10.6%, 2009: 6.9%), while those of obesity increased (2005: 8.1%, 2006: 9.8%, 2007: 12.7%, 2008: 11.0%, 2009: 14.3%). Differences between sickle cell disease and obesity in cholelithiasis patients are shown in the table. Sickle cell disease patients were younger (11.69 ± 3.98 years vs. obesity 14.97 ± 2.16 years, p<0.001). There is no difference in total charges or mortality. In 2005, the most significant factors for cholelithiasis on logistic regression were SCD (Odds Ratio, OR 15.550[12.581-19.221]), obesity (OR 4.460[3.663-5.432]), Native American race (OR 3.094[2.024-4.729]), and female gender (OR 1.884[1.669-2.127]). In 2009, obesity and female gender experienced an increase in likelihood (OR 5.866[5.046-6.818], and OR 2.400[2.115-2.723] respectively), while SCD (OR 14.735[11.459-18.948]) and Native American race (OR 2.477[1.740-3.525]) had decreased likelihood.
Conclusion: The rate of pediatric cholelithiasis has remained stable over these 5 years. However, as the prevalence of obesity has increased, so has the rate of cholelithiasis in obese children unrelated to hemolysis as seen in SCD. It could be anticipated that this trend will become more apparent if national obesity rates continue to rise. Additionally, SCD was associated with younger and sicker patients, which could account for lower rates of surgical intervention. Despite this, there were no clinically significant differences in outcomes.
