Gallstone pancreatitis in older patients

Are we operating enough?

Marc D. Trust, Kristin M. Sheffield, Casey A. Boyd, Jaime Benarroch-Gampel, Dong Zhang, Courtney Townsend, Taylor S. Riall

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background: The recommended therapy for mild gallstone pancreatitis is cholecystectomy on initial hospitalization. Methods: Using a 5% national Medicare sample (1996-2005), we evaluated adherence to current recommendations for gallstone pancreatitis (cholecystectomy rates on initial hospitalization and the use of endoscopic retrograde cholangiopancreatography [ERCP]/ sphincterotomy). We evaluated predictors of cholecystectomy, gallstone-related readmissions, and 2-year mortality. Results: Adherence to current guidelines was low. Only 57% of 8,452 Medicare beneficiaries presenting to an acute care hospital with a first episode of mild gallstone pancreatitis underwent cholecystectomy on initial hospitalization. Of the patients who did not undergo cholecystectomy, 55% were never evaluated by a surgeon. Likewise, only 28% of patients who did not undergo cholecystectomy had a sphincterotomy. The 2-year readmission rates were higher among patients who did not undergo cholecystectomy (44% vs 4%; P <.0001), and 33% of these patients required cholecystectomy after discharge. In the no cholecystectomy group, ERCP prevented readmissions (hazard ratio, 0.53; 95% confidence interval, 0.47-0.61) and when readmissions occurred they were less likely to be for gallstone pancreatitis in patients who had an ERCP (27.8% vs 53.2%; P <.0001). On multivariate analysis, patients who were older, black, admitted to a nonsurgical service, lived in certain US regions, and had specific comorbidities were less likely to undergo cholecystectomy. Conclusion: Adherence to current recommendations for the management of mild gallstone pancreatitis is low in older patients. Our data suggest that >40% of patients who did not undergo cholecystectomy would have benefited from early definitive therapy. Implementation of policies to increase adherence to guidelines would prevent gallstone-related morbidity and mortality in older patients.

Original languageEnglish (US)
Pages (from-to)515-525
Number of pages11
JournalSurgery
Volume150
Issue number3
DOIs
StatePublished - Sep 2011

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Cholecystectomy
Gallstones
Pancreatitis
Hospitalization
Medicare
Guideline Adherence
Mortality
Endoscopic Retrograde Cholangiopancreatography
Secondary Prevention
Guidelines
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Trust, M. D., Sheffield, K. M., Boyd, C. A., Benarroch-Gampel, J., Zhang, D., Townsend, C., & Riall, T. S. (2011). Gallstone pancreatitis in older patients: Are we operating enough? Surgery, 150(3), 515-525. https://doi.org/10.1016/j.surg.2011.07.072

Gallstone pancreatitis in older patients : Are we operating enough? / Trust, Marc D.; Sheffield, Kristin M.; Boyd, Casey A.; Benarroch-Gampel, Jaime; Zhang, Dong; Townsend, Courtney; Riall, Taylor S.

In: Surgery, Vol. 150, No. 3, 09.2011, p. 515-525.

Research output: Contribution to journalArticle

Trust, MD, Sheffield, KM, Boyd, CA, Benarroch-Gampel, J, Zhang, D, Townsend, C & Riall, TS 2011, 'Gallstone pancreatitis in older patients: Are we operating enough?', Surgery, vol. 150, no. 3, pp. 515-525. https://doi.org/10.1016/j.surg.2011.07.072
Trust MD, Sheffield KM, Boyd CA, Benarroch-Gampel J, Zhang D, Townsend C et al. Gallstone pancreatitis in older patients: Are we operating enough? Surgery. 2011 Sep;150(3):515-525. https://doi.org/10.1016/j.surg.2011.07.072
Trust, Marc D. ; Sheffield, Kristin M. ; Boyd, Casey A. ; Benarroch-Gampel, Jaime ; Zhang, Dong ; Townsend, Courtney ; Riall, Taylor S. / Gallstone pancreatitis in older patients : Are we operating enough?. In: Surgery. 2011 ; Vol. 150, No. 3. pp. 515-525.
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abstract = "Background: The recommended therapy for mild gallstone pancreatitis is cholecystectomy on initial hospitalization. Methods: Using a 5{\%} national Medicare sample (1996-2005), we evaluated adherence to current recommendations for gallstone pancreatitis (cholecystectomy rates on initial hospitalization and the use of endoscopic retrograde cholangiopancreatography [ERCP]/ sphincterotomy). We evaluated predictors of cholecystectomy, gallstone-related readmissions, and 2-year mortality. Results: Adherence to current guidelines was low. Only 57{\%} of 8,452 Medicare beneficiaries presenting to an acute care hospital with a first episode of mild gallstone pancreatitis underwent cholecystectomy on initial hospitalization. Of the patients who did not undergo cholecystectomy, 55{\%} were never evaluated by a surgeon. Likewise, only 28{\%} of patients who did not undergo cholecystectomy had a sphincterotomy. The 2-year readmission rates were higher among patients who did not undergo cholecystectomy (44{\%} vs 4{\%}; P <.0001), and 33{\%} of these patients required cholecystectomy after discharge. In the no cholecystectomy group, ERCP prevented readmissions (hazard ratio, 0.53; 95{\%} confidence interval, 0.47-0.61) and when readmissions occurred they were less likely to be for gallstone pancreatitis in patients who had an ERCP (27.8{\%} vs 53.2{\%}; P <.0001). On multivariate analysis, patients who were older, black, admitted to a nonsurgical service, lived in certain US regions, and had specific comorbidities were less likely to undergo cholecystectomy. Conclusion: Adherence to current recommendations for the management of mild gallstone pancreatitis is low in older patients. Our data suggest that >40{\%} of patients who did not undergo cholecystectomy would have benefited from early definitive therapy. Implementation of policies to increase adherence to guidelines would prevent gallstone-related morbidity and mortality in older patients.",
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AU - Trust, Marc D.

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AU - Benarroch-Gampel, Jaime

AU - Zhang, Dong

AU - Townsend, Courtney

AU - Riall, Taylor S.

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N2 - Background: The recommended therapy for mild gallstone pancreatitis is cholecystectomy on initial hospitalization. Methods: Using a 5% national Medicare sample (1996-2005), we evaluated adherence to current recommendations for gallstone pancreatitis (cholecystectomy rates on initial hospitalization and the use of endoscopic retrograde cholangiopancreatography [ERCP]/ sphincterotomy). We evaluated predictors of cholecystectomy, gallstone-related readmissions, and 2-year mortality. Results: Adherence to current guidelines was low. Only 57% of 8,452 Medicare beneficiaries presenting to an acute care hospital with a first episode of mild gallstone pancreatitis underwent cholecystectomy on initial hospitalization. Of the patients who did not undergo cholecystectomy, 55% were never evaluated by a surgeon. Likewise, only 28% of patients who did not undergo cholecystectomy had a sphincterotomy. The 2-year readmission rates were higher among patients who did not undergo cholecystectomy (44% vs 4%; P <.0001), and 33% of these patients required cholecystectomy after discharge. In the no cholecystectomy group, ERCP prevented readmissions (hazard ratio, 0.53; 95% confidence interval, 0.47-0.61) and when readmissions occurred they were less likely to be for gallstone pancreatitis in patients who had an ERCP (27.8% vs 53.2%; P <.0001). On multivariate analysis, patients who were older, black, admitted to a nonsurgical service, lived in certain US regions, and had specific comorbidities were less likely to undergo cholecystectomy. Conclusion: Adherence to current recommendations for the management of mild gallstone pancreatitis is low in older patients. Our data suggest that >40% of patients who did not undergo cholecystectomy would have benefited from early definitive therapy. Implementation of policies to increase adherence to guidelines would prevent gallstone-related morbidity and mortality in older patients.

AB - Background: The recommended therapy for mild gallstone pancreatitis is cholecystectomy on initial hospitalization. Methods: Using a 5% national Medicare sample (1996-2005), we evaluated adherence to current recommendations for gallstone pancreatitis (cholecystectomy rates on initial hospitalization and the use of endoscopic retrograde cholangiopancreatography [ERCP]/ sphincterotomy). We evaluated predictors of cholecystectomy, gallstone-related readmissions, and 2-year mortality. Results: Adherence to current guidelines was low. Only 57% of 8,452 Medicare beneficiaries presenting to an acute care hospital with a first episode of mild gallstone pancreatitis underwent cholecystectomy on initial hospitalization. Of the patients who did not undergo cholecystectomy, 55% were never evaluated by a surgeon. Likewise, only 28% of patients who did not undergo cholecystectomy had a sphincterotomy. The 2-year readmission rates were higher among patients who did not undergo cholecystectomy (44% vs 4%; P <.0001), and 33% of these patients required cholecystectomy after discharge. In the no cholecystectomy group, ERCP prevented readmissions (hazard ratio, 0.53; 95% confidence interval, 0.47-0.61) and when readmissions occurred they were less likely to be for gallstone pancreatitis in patients who had an ERCP (27.8% vs 53.2%; P <.0001). On multivariate analysis, patients who were older, black, admitted to a nonsurgical service, lived in certain US regions, and had specific comorbidities were less likely to undergo cholecystectomy. Conclusion: Adherence to current recommendations for the management of mild gallstone pancreatitis is low in older patients. Our data suggest that >40% of patients who did not undergo cholecystectomy would have benefited from early definitive therapy. Implementation of policies to increase adherence to guidelines would prevent gallstone-related morbidity and mortality in older patients.

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