Why are we performing fewer cholecystectomies for mild acute biliary pancreatitis?Trends and predictors of cholecystectomy from the National Readmissions Database(2010–2014)

作     者：Sushil Kumar Garg Fateh Bazerbachi Shashank Sarvepalli Shounak Majumder Shanthi Swaroop Vege 

作者机构：Division of Gastroenterology and HepatologyMayo ClinicRochesterMNUSA Division of GastroenterologyMassachusetts General HospitalBostonMAUSA Department of Hospital MedicineCleveland ClinicClevelandOHUSA 

出 版 物：《Gastroenterology Report》 (胃肠病学报道（英文）)

年 卷 期：2019年第7卷第5期

页      面：331-337,I0002页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：cholecystectomy mild acute biliary pancreatitis National Readmissions Database endoscopic retrograde cholangiopancreatography 

摘      要：Background:Current guidelines recommend cholecystectomy for patients with mild acute biliary pancreatitis(MABP)during the index admission because it is associated with better *** this study,we aimed to assess national trends in cholecystectomy during index admissions for MABP and to identify factors associated with cholecystectomy completion and 30-day ***:Using diagnostic codes and the National Readmissions Database,we identified patients admitted with MABP between 2010 and *** in cholecystectomy rates were computed on the basis of various *** conducted a multivariable analysis to identify factors associated with 30-day readmission and cholecystectomy during the same ***:We identified 255,695 unique index MABP cases(41.3%male)and the 30-day readmission rate was 12.6%.Overall,43.8%underwent cholecystectomy and 25%underwent endoscopic retrograde cholangiopancreatography(ERCP)with *** observed a decreasing trend in both procedures during the study period(P0.001).In multivariate analysis,odds of 30-day readmission were reduced for patients undergoing ERCP with sphincterotomy(odds ratio,0.78;95%confidence interval,0.74–0.84)or cholecystectomy(odds ratio,0.37;95%confidence interval,0.35–0.39).Conclusions:For patients with MABP,cholecystectomy or ERCP with sphincterotomy during the index admission decreased the risk of 30-day *** this benefit and national guidelines recommending cholecystectomy during the index MABP admission,the rate of cholecystectomies performed nationally decreased during the study *** research is needed to understand the implications and reasons underlying this deviation from guidelines.