Clinical and Translational Research
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 16, 2024; 16(6): 350-360
Published online Jun 16, 2024. doi: 10.4253/wjge.v16.i6.350
Impact of index admission cholecystectomy vs interval cholecystectomy on readmission rate in acute cholangitis: National Readmission Database survey
Abdullah Sohail, Ahmed Shehadah, Ammad Chaudhary, Khadija Naseem, Amna Iqbal, Ahmad Khan, Shailendra Singh
Abdullah Sohail, Department of Internal Medicine, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa, IA 52242, United States
Ahmed Shehadah, Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, United States
Ammad Chaudhary, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, United States
Khadija Naseem, Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195-0001, United States
Amna Iqbal, Department of Internal Medicine, University of Toledo, Toledo, OH 43606, United States
Ahmad Khan, Department of Gastroenterology and Hepatology, Case Western Reserve University Hospital, Cleveland, OH 44106, United States
Shailendra Singh, Division of Gastroenterology and Hepatology, West Virginia University School of Medicine, Morgantown, WV 26505, United States
Author contributions: Sohail A, Shehadah A, Chaudhary A, Naseem K, Iqbal A, Khan A, and Singh S were involved in the conceptualization and development of the project; Sohail A, Shehadah A, and Chaudhary A contributed to the obtaining and comprehending of the data; and all authors thoroughly reviewed the project for important intellectual content and endorsed the final draft for publication.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abdullah Sohail, MD, Assistant Professor, Department of Internal Medicine, University of Iowa Roy J and Lucille A Carver College of Medicine, 200 Hawkins Dr, Iowa, IA 52242, United States. abdullahsohailmd@gmail.com
Received: February 25, 2024
Revised: April 25, 2024
Accepted: May 10, 2024
Published online: June 16, 2024
Processing time: 109 Days and 11.3 Hours
Abstract
BACKGROUND

Elective cholecystectomy (CCY) is recommended for patients with gallstone-related acute cholangitis (AC) following endoscopic decompression to prevent recurrent biliary events. However, the optimal timing and implications of CCY remain unclear.

AIM

To examine the impact of same-admission CCY compared to interval CCY on patients with gallstone-related AC using the National Readmission Database (NRD).

METHODS

We queried the NRD to identify all gallstone-related AC hospitalizations in adult patients with and without the same admission CCY between 2016 and 2020. Our primary outcome was all-cause 30-d readmission rates, and secondary outcomes included in-hospital mortality, length of stay (LOS), and hospitalization cost.

RESULTS

Among the 124964 gallstone-related AC hospitalizations, only 14.67% underwent the same admission CCY. The all-cause 30-d readmissions in the same admission CCY group were almost half that of the non-CCY group (5.56% vs 11.50%). Patients in the same admission CCY group had a longer mean LOS and higher hospitalization costs attributable to surgery. Although the most common reason for readmission was sepsis in both groups, the second most common reason was AC in the interval CCY group.

CONCLUSION

Our study suggests that patients with gallstone-related AC who do not undergo the same admission CCY have twice the risk of readmission compared to those who undergo CCY during the same admission. These readmissions can potentially be prevented by performing same-admission CCY in appropriate patients, which may reduce subsequent hospitalization costs secondary to readmissions.

Keywords: Acute cholangitis, Gallstone-related complications, National Readmission Database, 30-d readmission rates, Resource utilization, In-hospital mortality

Core Tip: Utilizing the National Readmission Database, we examined the outcomes of index admission cholecystectomy (CCY) vs interval CCY in patients with gallstone-related acute cholangitis (AC). This study revealed that patients undergoing CCY during the same hospital admission for AC exhibited significantly lower 30-d readmission rates than those receiving interval CCY. This approach not only reduces the frequency of subsequent acute hospital visits but also highlights the potential cost benefits by lowering hospitalization expenses. These findings advocate for a reevaluation of current clinical practices concerning the timing of CCY post- endoscopic retrograde cholangiopancreatography, suggesting that earlier interventions could enhance patient outcomes and optimize resource utilization.