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Pathak SJ, Avila P, Dai SC, Arain MA, Perito ER, Kouanda A. Index admission cholecystectomy for biliary acute pancreatitis or choledocholithiasis reduces 30-day readmission rates in children. Surg Endosc 2024; 38:2649-2656. [PMID: 38503905 PMCID: PMC11078817 DOI: 10.1007/s00464-024-10790-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/07/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Adult patients with biliary acute pancreatitis (BAP) or choledocholithiasis who do not undergo cholecystectomy on index admission have worse outcomes. Given the paucity of data on the impact of cholecystectomy during index hospitalization in children, we examined readmission rates among pediatric patients with BAP or choledocholithiasis who underwent index cholecystectomy versus those who did not. METHODS Retrospective study of children (< 18 years old) admitted with BAP, without infection or necrosis (ICD-10 K85.10), or choledocholithiasis (K80.3x-K80.7x) using the 2018 National Readmission Database (NRD). Exclusion criteria were necrotizing pancreatitis with or without infected necrosis and death during index admission. Multivariable logistic regression was performed to identify factors associated with 30-day readmission. RESULTS In 2018, 1122 children were admitted for index BAP (n = 377, 33.6%) or choledocholithiasis (n = 745, 66.4%). Mean age at admission was 13 (SD 4.2) years; most patients were female (n = 792, 70.6%). Index cholecystectomy was performed in 663 (59.1%) of cases. Thirty-day readmission rate was 10.9% in patients who underwent cholecystectomy during that index admission and 48.8% in those who did not (p < 0.001). In multivariable analysis, patients who underwent index cholecystectomy had lower odds of 30-day readmission than those who did not (OR 0.16, 95% CI 0.11-0.24, p < 0.001). CONCLUSIONS Index cholecystectomy was performed in only 59% of pediatric patients admitted with BAP or choledocholithiasis but was associated with 84% decreased odds of readmission within 30 days. Current guidelines should be updated to reflect these findings, and future studies should evaluate barriers to index cholecystectomy.
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Affiliation(s)
- Sagar J Pathak
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
| | - Patrick Avila
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sun-Chuan Dai
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mustafa A Arain
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Division of Gastroenterology, Department of Medicine, Center for Interventional Endoscopy, AdventHealth, Orlando, FL, USA
| | - Emily R Perito
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Abdul Kouanda
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Bergeron E, Doyon T, Manière T, Désilets É. Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event. Surg Endosc 2023; 37:9546-9555. [PMID: 37726412 PMCID: PMC10709473 DOI: 10.1007/s00464-023-10423-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Gallstone disease will affect 15% of the adult population with concomitant common bile duct stone (CBDS) occurring in up to 30%. Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of management for removal of CBDS, as cholecystectomy for the prevention of recurrent biliary event (RBE). RBE occurs in up to 47% if cholecystectomy is not done. The goal of this study was to evaluate the timing of occurrence of RBE after common bile duct clearance with ERCP and associated outcomes. METHODS The records of all patients who underwent ERCP for gallstone disease followed by cholecystectomy, in a single center from 2010 to 2022, were reviewed. All RBE were identified. Actuarial incidence of RBE was built. Patients with and without RBE were compared. RESULTS The study population is composed of 529 patients. Mean age was 58.0 (18-95). There were 221 RBE in 151 patients (28.5%), 39/151 (25.8%) having more than one episode. The most frequent RBE was acute cholecystitis (n = 104) followed by recurrent CBDS (n = 95). Median time for first RBE was 34 days. Actuarial incidence of RBE started from 2.5% at 7 days to reach 53.3% at 1 year. Incidence-rate of RBE was 2.9 per 100 person-months. Patients with RBE had significant longer hospitalisation time (11.7 vs 6.4 days; P < 0.0001), longer operative time (66 vs 48 min; P < 0.0001), longer postoperative stay (2.9 vs 0.9 days; P < 0.0001), higher open surgery rate (7.9% vs 1.3%; P < 0.0001), and more complicated pathology (23.8% vs 5.8%; P < 0.0001) and cholecystitis (64.2% vs 25.9%; P < 0.0001) as final diagnoses. CONCLUSIONS RBE occurred in 28.5% of the subjects at a median time of 34 days, with an incidence of 2.5% as early as 1 week. Cholecystectomy should be done preferably within 7 days after common bile duct clearance in order to prevent RBE and adverse outcomes.
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Affiliation(s)
- Eric Bergeron
- Department of Surgery, Charles-LeMoyne Hospital, 3120, Boulevard Taschereau, Greenfield Park, QC, J4V 2H1, Canada.
| | - Théo Doyon
- Department of Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, QC, Canada
| | - Thibaut Manière
- Department of Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, QC, Canada
| | - Étienne Désilets
- Department of Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, QC, Canada
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Bergeron E, Doyon T, Manière T, Désilets É. Cholecystectomy following endoscopic clearance of common bile duct during the same admission. Can J Surg 2023; 66:E477-E484. [PMID: 37734850 PMCID: PMC10521812 DOI: 10.1503/cjs.008322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The recurrence of common bile duct stones and other biliary events after endoscopic retrograde cholangiopancreatography (ERCP) is frequent. Despite recommendations for early cholecystectomy, intervention during the same admission is carried out inconsistently. METHODS We reviewed the records of patients who underwent ERCP for gallstone disease and common bile duct clearance followed by cholecystectomy between July 2012 and June 2022. Patients were divided into 2 groups: the index group underwent cholecystectomy during the same admission and the delayed group was discharged and had their cholecystectomy postponed. Data on demographics and prognosis factors were collected and analyzed. RESULTS The study population was composed of 268 patients, with 71 (26.6%) having undergone cholecystectomy during the same admission after common bile duct clearance with ERCP. A greater proportion of patients aged 80 years and older were in the index group than in the delayed group. The American Society of Anesthesiologists score was significantly higher in the index group. There was no significant difference between groups regarding surgical complications, open cholecystectomy and death. The operative time was significantly longer in the delayed group. Among patients with delayed cholecystectomy, 18.3% had at least 1 recurrence of common bile duct stones (CBDS) and 38.6% had recurrence of any gallstone-related events before cholecystectomy. None of these events occurred in the the index group. There was no difference in the recurrence of CBDS and other biliary events after initial diagnosis associated with stone disease. CONCLUSION Cholecystectomy during the same admission after common bile duct clearance is safe, even in older adults with comorbidities. Compared with delayed cholecystectomy, it was not associated with adverse outcomes and may have prevented recurrence of biliary events.
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Affiliation(s)
- Eric Bergeron
- Department of Surgery, Hôpital Charles LeMoyne, Greenfield Park, Que. (Bergeron); Department of Gastroenterology, Hôpital Charles LeMoyne, Greenfield Park, Que. (Doyon, Maniere, Desilets)
| | - Théo Doyon
- Department of Surgery, Hôpital Charles LeMoyne, Greenfield Park, Que. (Bergeron); Department of Gastroenterology, Hôpital Charles LeMoyne, Greenfield Park, Que. (Doyon, Maniere, Desilets)
| | - Thibaut Manière
- Department of Surgery, Hôpital Charles LeMoyne, Greenfield Park, Que. (Bergeron); Department of Gastroenterology, Hôpital Charles LeMoyne, Greenfield Park, Que. (Doyon, Maniere, Desilets)
| | - Étienne Désilets
- Department of Surgery, Hôpital Charles LeMoyne, Greenfield Park, Que. (Bergeron); Department of Gastroenterology, Hôpital Charles LeMoyne, Greenfield Park, Que. (Doyon, Maniere, Desilets)
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Readmission in acute pancreatitis: Etiology, risk factors, and opportunities for improvement. Surg Open Sci 2022; 10:232-237. [DOI: 10.1016/j.sopen.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 09/19/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
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Nomogram for the Prediction of 30-Day Readmission in Acute Pancreatitis. Dig Dis Sci 2022; 67:4112-4121. [PMID: 34727282 DOI: 10.1007/s10620-021-07236-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/22/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND A prediction model for 30-day readmission in patients with acute pancreatitis (AP) was needed. AIMS To develop a nomogram to predict 30-day readmission in patients with AP and validate the usefulness of serum indicators after discharge for the prediction of 30-day readmission. METHODS This was a retrospective cohort study enrolling patients with the first attack of AP. Baseline characteristics, clinical profiles, and serum indicators after discharge were compared. Multivariate logistic regression analysis and a nomogram were employed to determine the independent risk factors for 30-day readmission. RESULTS A total of 7.32% (121/1653) of the patients were readmitted within 30 days after discharge. Different etiologies (biliary pancreatitis (adjusted odds ratio (AdjOR), 9.63; 95% confidence interval (CI), 1.28-72.52; P = 0.028), other causes (AdjOR, 9.37; 95% CI, 1.15-76.12, P = 0.026), mixed causes (AdjOR, 10.76; 95% CI, 1.27-91.35; P = 0.03) compared with alcoholic pancreatitis)), infected pancreatitis necrosis (IPN) (AdjOR, 2.3; 95% CI, 1.2-4.42; P = 0.013), total bilirubin level ≥ 20.5 µmol/L (AdjOR, 2.42; 95% CI, 1.23-4.77; P = 0.01), glucose level ≥ 6.1 mmol/L (AdjOR, 1.93; 95% CI, 1.16-3.19; P = 0.011), and albumin level < 40 g/L (AdjOR, 4.25; 95% CI, 2.44-7.41; P < 0.001) were independently associated with 30-day readmission. A nomogram incorporating these factors demonstrated good discrimination, calibration, and clinical utility. Serum indicators after discharge added predictive value compared with clinical variables alone (AUC, 0.78 vs. 0.685; P = 0.0001). CONCLUSIONS The nomogram combining etiology, IPN, and serum indicators after discharge has favorable predictive performance for 30-Day readmission. The close monitoring and reexamination of serum indicators are essential for AP patients at high risk.
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Quality of Care for Gallstone Pancreatitis-the Impact of the Acute Care Surgery Model and Hospital-Level Operative Resources. J Gastrointest Surg 2022; 26:849-860. [PMID: 34786665 DOI: 10.1007/s11605-021-05145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/27/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Index cholecystectomy is the standard of care for gallstone pancreatitis. Hospital-level operative resources and implementation of an acute care surgery (ACS) model may impact the ability to perform index cholecystectomy. We aimed to determine the influence of structure and process measures related to operating room access on achieving index cholecystectomy for gallstone pancreatitis. METHODS In 2015, we surveyed 2811 US hospitals on ACS practices, including infrastructure for operative access. A total of 1690 hospitals (60%) responded. We anonymously linked survey data to 2015 State Inpatient Databases from 17 states using American Hospital Association identifiers. We identified patients ≥ 18 years who were admitted with gallstone pancreatitis. Patients transferred from another facility were excluded. Univariate and multivariable regression analyses, clustered by hospital and adjusted for patient factors, were performed to examine multiple structure and process variables related to achieving an index cholecystectomy rate of ≥ 75% (high performers). RESULTS Over the study period, 5656 patients were admitted with gallstone pancreatitis and 70% had an index cholecystectomy. High-performing hospitals achieved an index cholecystectomy rate of 84.1% compared to 58.5% at low-performing hospitals. On multivariable regression analysis, only teaching vs. non-teaching hospital (OR 2.91, 95% CI 1.11-7.70) and access to dedicated, daytime operative resources (i.e., block time) vs. no/little access (OR 1.93, 95% CI 1.11-3.37) were associated with high-performing hospitals. CONCLUSIONS Access to dedicated, daytime operative resources is associated with high quality of care for gallstone pancreatitis. Health systems should consider the addition of dedicated, daytime operative resources for acute care surgery service lines to improve patient care.
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The Need for Standardizing Diagnosis, Treatment and Clinical Care of Cholecystitis and Biliary Colic in Gallbladder Disease. Medicina (B Aires) 2022; 58:medicina58030388. [PMID: 35334564 PMCID: PMC8949253 DOI: 10.3390/medicina58030388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 02/06/2023] Open
Abstract
Gallstones affect 20% of the Western population and will grow in clinical significance as obesity and metabolic diseases become more prevalent. Gallbladder removal (cholecystectomy) is a common treatment for diseases caused by gallstones, with 1.2 million surgeries in the US each year, each costing USD 10,000. Gallbladder disease has a significant impact on the logistics and economics of healthcare. We discuss the two most common presentations of gallbladder disease (biliary colic and cholecystitis) and their pathophysiology, risk factors, signs and symptoms. We discuss the factors that affect clinical care, including diagnosis, treatment outcomes, surgical risk factors, quality of life and cost-efficacy. We highlight the importance of standardised guidelines and objective scoring systems in improving quality, consistency and compatibility across healthcare providers and in improving patient outcomes, collaborative opportunities and the cost-effectiveness of treatment. Guidelines and scoring only exist in select areas of the care pathway. Opportunities exist elsewhere in the care pathway.
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Rios-Diaz AJ, Lamm R, Metcalfe D, Devin CL, Pucci MJ, Palazzo F. National recurrence of pancreatitis and readmissions after biliary pancreatitis. Surg Endosc 2022; 36:7399-7408. [PMID: 35233658 DOI: 10.1007/s00464-022-09153-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/17/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND National and international guidelines support early cholecystectomy after mild gallstone pancreatitis but a recent nationwide study suggested these recommendations are not universally followed. Our study sought to quantify the national utilization of same hospitalization cholecystectomy versus non-operative management (NOM) and its association with pancreatitis recurrence, readmissions, and costs after mild gallstone pancreatitis (GP). METHODS Adult patients admitted with mild GP were identified from the Nationwide Readmission Database 2010-2015. Primary outcomes included the rate of cholecystectomy during the index admission as well as pancreatitis recurrence and readmission at 30 and 180 days (30d, 180d) comparing NOM to same hospitalization cholecystectomy. Mortality upon readmission, total length of stay (LOS), and total costs (combined index-readmission hospital costs) were also explored. Cox proportional hazards regression and generalized linear models controlled for patient/hospital confounders. RESULTS Among the 65,067 patients identified, 30% underwent cholecystectomy. The NOM cohort was older (58 vs. 50 years), had more comorbidities (Charlson index > 2, 23.5% vs. 11.5%), fewer female patients (56.7% vs. 67%) and less discharge-to-home (84.9% vs. 94.4%) (all p < 0.001). NOM was associated with increase in recurrence and unplanned readmissions at 30d [Hazard Ratio 3.53 (95% CI 2.92-4.27), 2.41 (2.11-2.74), respectively], and 180d [4.27 (3.65-4.98), 2.78 (2.54-3.04), respectively], as well as increased mortality during 180d readmission 1.88 (1.06-3.35). This approach was also associated with significant increase in LOS [predicted mean difference 2.79 days (95% CI 2.46-3.12)] and total costs [$2507.89 ($1714.4-$3301.4)]. CONCLUSIONS In the USA, most patients presenting with mild GP do not undergo same hospitalization cholecystectomy. This strategy results in higher recurrent pancreatitis, mortality during readmission, and an additional $4.85 M/year in hospital costs nationwide. These data support same hospitalization cholecystectomy as the gold standard for mild GP.
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Affiliation(s)
- Arturo J Rios-Diaz
- Department of Surgery, Thomas Jefferson University Hospital, 1015 Walnut Street, Philadelphia, PA, 19107, USA.
| | - Ryan Lamm
- Department of Surgery, Thomas Jefferson University Hospital, 1015 Walnut Street, Philadelphia, PA, 19107, USA
| | - David Metcalfe
- Rheumatology and Musculoskeletal Sciences (NDORMS), Nuffield Department of Orthopedics, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Courtney L Devin
- Department of Surgery, Thomas Jefferson University Hospital, 1015 Walnut Street, Philadelphia, PA, 19107, USA
| | - Michael J Pucci
- Department of Surgery, Thomas Jefferson University Hospital, 1015 Walnut Street, Philadelphia, PA, 19107, USA
| | - Francesco Palazzo
- Department of Surgery, Thomas Jefferson University Hospital, 1015 Walnut Street, Philadelphia, PA, 19107, USA
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Facundo HG, Montoliu RR, Llanos DRC, Naval GS, Millán EL, Gordo SL, Bosch JH, Rodríguez SL, Baranera MM, Martínez SG. Cholecystectomy 7 days vs 4 weeks after mild biliary pancreatitis; looking a decrease the incidence of persistent choledocholithiasis and ERCP: A multicentric randomized clinical trial. Int J Surg 2022; 98:106207. [PMID: 34995805 DOI: 10.1016/j.ijsu.2021.106207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/09/2021] [Accepted: 12/31/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Mild acute biliary pancreatitis (MABP) requires definitive treatment of the cholelithiasis to avoid recurrent biliary events. Recent publications recommend performing early surgery to prevent readmissions. However, an exceedingly early cholecystectomy could imply missing the presence of persistent choledocholithiasis or requiring a significant number of preoperative endoscopic retrograde cholangiopancreatographies (ERCP). This multicentre randomized clinical trial compares early surgery performed a week after MABP with delayed surgery (at 4 weeks), to compare readmission rates for recurrent biliary events and the incidence of residual choledocholithiasis between the two groups. MATERIALS AND METHODS A total of 198 patients with a first episode of MABP defined by the Atlanta 2012 criteria were enrolled. Randomization was done by a central study coordinator: 98 to early surgery and 100 to delayed surgery. All of them had preoperative or intraoperative imaging to exclude persistent choledocholithiasis. Laparoscopic cholecystectomy was performed by dedicated teams of experienced surgeons. RESULTS Early surgery reduced the rate of readmissions for biliary events before cholecystectomy by half (7.2% vs 15.8%, p = 0,058). There were no differences in the type of surgery, postoperative stay, or complications compared with delayed surgery. Choledocholithiasis was observed in 9.0% of patients in the early group and 7.7% in the delayed group (p 0,719). The preoperative or intraoperative imaging study avoided unnecessary ERCP, which was performed in only 6 (3%) patients. CONCLUSIONS Early cholecystectomy performed seven days after resolution of MABP had a low incidence of recurrent biliary events and complications, and was not associated with an increase in residual choledocholithiasis or need for unnecessary ERCP.
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Affiliation(s)
- Helena Gómez Facundo
- General and Digestive Surgery Department, Moisès Broggi Hospital, CSI, Barcelona, Spain General and Digestive Surgery Department, Sant Joan de Déu Hospital, Martorell, Barcelona, Spain General and Digestive Surgery Department, Joan XXIII Hospital, Tarragona, Spain General and Digestive Surgery Department, Consorci Sanitari Garraf, Sant Pere de Ribes, Barcelona, Spain General and Digestive Surgery Department, Consorci Sanitari Vic, Vic, Barcelona, Spain General and Digestive Surgery Department, Dos de Maig Hospital, Barcelona, Spain Epidemiology Department, Moisès Broggi Hospital, CSI, Barcelona, Spain
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Cienfuegos JA, Valentí V, Rotellar F. Acute pancreatitis: an opportunity for gastroenterology hospitalists? REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:73-75. [PMID: 35040330 DOI: 10.17235/reed.2022.8573/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Due to the heterogeneous character of acute pancreatitis and its high incidence, it is imperative to follow clinical guidelines to avoid readmissions or recurrences. Implementing new hospital structures such as hospitalists in gastroenterology offer new possibilities to provide patient-centred value.
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11
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National Trends in Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography During Index Hospitalization for Mild Gallstone Pancreatitis. World J Surg 2021; 46:524-530. [PMID: 34817621 DOI: 10.1007/s00268-021-06389-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Guidelines call for cholecystectomy during the index hospitalization for patients with gallstone pancreatitis. Therefore, the study sought to determine the trends for cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (ERCP) for mild gallstone pancreatitis. METHODS A retrospective analysis of the 2010-2018 Nationwide Readmission Database (NRD) was performed to identify patients with mild gallstone pancreatitis. The primary aim was to identify the trends in the use of cholecystectomy in these patients, and the secondary aim was to assess if ERCP alone was protective against readmission. RESULTS A total of 510,470 patients with mild gallstone pancreatitis were identified. There has been an increasing trend in ERCP use (25% in 2018 vs. 22% in 2010; p-0.001) and a decline in cholecystectomy (37% in 2018 vs. 46% in 2010; p-0.001) prior to discharge. Multivariate analysis revealed higher 30-day readmission for patients who underwent ERCP without cholecystectomy (odds ratio1.3; 95% confidence interval, 1.1-3.5) during the index admission. CONCLUSIONS There has been a decline in the use of cholecystectomy during index hospitalization for mild gallstone pancreatitis. In addition, ERCP was not protective against 30-day readmission from mild gallstone pancreatitis.
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Shmelev A, Axentiev A, Hossain MB, Cunningham SC. Predictors of same-admission cholecystectomy in mild, acute, biliary pancreatitis. HPB (Oxford) 2021; 23:1674-1682. [PMID: 34099373 DOI: 10.1016/j.hpb.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 12/24/2020] [Accepted: 04/06/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Failure to perform same-admission cholecystectomy (SA-CCY) for mild, acute, biliary pancreatitis (MABP) is a recognized risk factor for recurrence and readmission. However, rates of SA-CCY are low and factors associated with these low rates require elucidation. METHODS Primary MAPB admissions were pooled from NIS 2000-2014 (weighted n = 578 258). Patients with chronic pancreatitis, pancreatic masses, alcohol-related disorders, hypertriglyceridemia, acute cholecystitis and AP-related organ dysfunction or complications were excluded. Annual rates of SA-CCY were calculated. Regression model for prediction of SA-CCY was built on 2010-2011 subset (weighted n = 74 169), yielding 96.3% of complete observations. RESULTS Nationwide rate of SA-CCY in the U.S. was 40.8%. In multivariate analysis, SA-CCY was positively associated with BMI>30 (OR = 1.4, 95%CI 1.2-1.6), Asian ethnicity (vs. Black; OR = 1.2, 95%CI 1.0-1.5), private insurance (vs. Medicare; OR = 1.1, 95%CI 1.0-1.3), large (vs. small; OR = 1.3, 95%CI 1.2-1.4) urban hospitals (vs. rural; OR = 1.5 95%CI 1.3-1.7) of the South (vs. Northeast; OR = 1.5, 95%CI 1.3-1.7), as well as with chronic cholecystitis (OR = 17.0, 95%CI 15.4-18.7) and abdominal-wall hernias (OR = 5.2; 95%CI 3.0-8.9); the latter two predictors were not included in the final model. SA-CCY was negatively associated with age >40 (OR = 0.72; 95%CI 0.66-0.79), male gender (OR = 0.86, 95%CI 0.80-0.93), dementia (OR = 0.88, 95%CI 0.72-1.1), chronic comorbidities (OR = 0.64; 95%CI 0.54-0.77) and ostomies (OR = 0.51; 95%CI 0.31-0.86). CONCLUSION Adherence to SA-CCY guidelines for MABP remains inadequate. Independent geographic variation in SA-CCY rates may be related to reimbursement differences, ownership of AP patients, accessibility to surgical care, or cultural characteristics of the patient population.
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Affiliation(s)
- Artem Shmelev
- Department of Surgery, Saint Agnes Healthcare, Baltimore, MD, USA.
| | - Anna Axentiev
- Department of Surgery, Saint Agnes Healthcare, Baltimore, MD, USA
| | - Mian B Hossain
- School of Community Health and Policy, Morgan State University, Baltimore, MD, USA
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Chu BK, Gnyawali B, Cloyd JM, Hart PA, Papachristou GI, Lara LF, Groce JR, Hinton A, Conwell DL, Krishna SG. Early unplanned readmissions following same-admission cholecystectomy for acute biliary pancreatitis. Surg Endosc 2021; 36:3001-3010. [PMID: 34159465 DOI: 10.1007/s00464-021-08595-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/06/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Same-admission cholecystectomy (CCY) is recommended for mild acute biliary pancreatitis (biliary-AP). However, there is a paucity of research investigating reasons for early (30-day) unplanned readmissions in patients who undergo CCY for biliary-AP. Hence, we sought to investigate this gap using a large population database. METHODS Using the Nationwide Readmission Database (2010-2014), we identified all adults (age ≥ 18 years) with a principal diagnosis of biliary-AP who had undergone CCY during the index hospitalization. Multivariable logistic regression models were obtained to assess independent predictors for 30-day readmission. Principal diagnosis for all readmissions was collected to ascertain the indications for early readmission. RESULTS During the study period, 118,224 patients underwent same-admission CCY for biliary-AP. Three-fourths of all patients underwent invasive cholangiography during the hospitalization (intraoperative cholangiogram (IOC) = 57,038, ERCP = 31,500). The rate of early (30-day) readmission was 7.25% (n = 8574). Exacerbation of prior medical conditions (42.2%), sequelae of biliary-AP (resolving and recurrent pancreatitis, pseudocysts) (27.6%), surgical site and other postoperative complications (16%), choledocholithiasis and/or bile leak (9.6%), and preventable hospital-acquired conditions (4.6%) accounted for early readmissions. On multivariable analysis, predictors for readmission included male sex (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.08-1.28), insurance type (Medicare insurance [OR 1.26, 95% CI 1.13-1.40]; Medicaid [OR 1.22, 95% CI 1.09-1.38]), outside-facility discharge (OR 1.35, 95% CI 1.16-1.57), severe AP (OR 1.35, 95% CI 1.21-1.50), and ≥ 3 Elixhauser comorbidities (OR 1.55, 95% CI 1.41-1.69). Performance of IOC (OR 0.90, 95% CI 0.82-0.97) and ERCP (OR 0.81, 95% CI 0.73-0.89) were associated with decreased risk of early readmission. CONCLUSION In this study, using a national population database evaluating patients who underwent same-admission CCY after biliary-AP, we identified potentially modifiable risk factors and causes for early readmission as well as opportunities to improve clinical care.
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Affiliation(s)
- Brandon K Chu
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Bipul Gnyawali
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jordan M Cloyd
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center, James Cancer Center and Solove Research Institute, Columbus, OH, USA
| | - Phil A Hart
- Section of Pancreatic Disorders and Advanced Endoscopy, Division of Gastroenterology, Hepatology, & Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Columbus, OH, 43210, USA
| | - Georgios I Papachristou
- Section of Pancreatic Disorders and Advanced Endoscopy, Division of Gastroenterology, Hepatology, & Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Columbus, OH, 43210, USA
| | - Luis F Lara
- Section of Pancreatic Disorders and Advanced Endoscopy, Division of Gastroenterology, Hepatology, & Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Columbus, OH, 43210, USA
| | - Jeffrey R Groce
- Section of Pancreatic Disorders and Advanced Endoscopy, Division of Gastroenterology, Hepatology, & Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Columbus, OH, 43210, USA
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Darwin L Conwell
- Section of Pancreatic Disorders and Advanced Endoscopy, Division of Gastroenterology, Hepatology, & Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Columbus, OH, 43210, USA
| | - Somashekar G Krishna
- Section of Pancreatic Disorders and Advanced Endoscopy, Division of Gastroenterology, Hepatology, & Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Columbus, OH, 43210, USA.
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Abstract
OBJECTIVES There is a paucity of studies evaluating predictors of new-onset diabetes mellitus (DM) after acute pancreatitis (AP-related DM). We used a population-based database to evaluate predictors of AP-related DM. METHODS The Nationwide Readmissions Database (2010-2014) was used to identify all nondiabetic adults with an index primary diagnosis of AP. Multiple exclusions were applied to identify cohorts with and without AP-related DM. A case-control study was conducted to identify risk factors for developing AP-related DM within the calendar year. RESULTS We identified 2510 subjects with AP-related DM and 40,308 controls with AP who did not develop DM. Multivariable analysis revealed that increasing age (50-64 years; adjusted odds ratio [aOR], 1.35; 95% confidence interval [CI], 1.14-1.60), male sex (aOR, 1.2; 95% CI, 1.03-1.40), lowest income quartile (aOR, 1.48; 95% CI, 1.18-1.84), Elixhauser comorbidity index of 3 or higher (aOR, 1.47; 95% CI, 1.23-1.75), components of metabolic syndrome (aOR, 2.12; 95% CI, 1.21-3.70), severe AP (aOR, 1.60; 95% CI, 1.34-1.90), and recurrent AP (aOR, 1.46; 95% CI, 1.24-1.72) were independently associated with increased risk of AP-related DM. CONCLUSIONS These population-level variables predictive of developing AP-related DM can potentially identify patients who may benefit from closer follow-up, intensive education, and implementation of preventative strategies.
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15
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Shmelev A, Sill AM, Horrigan T, Cunningham SC. Trends and seasonality in hospitalizations for acute alcohol-related and biliary pancreatitis in the USA. Hepatobiliary Pancreat Dis Int 2021; 20:173-181. [PMID: 33158727 DOI: 10.1016/j.hbpd.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The incidence of acute pancreatitis (AP) is characterized by circannual and geographical variation. The aim of this study was to describe seasonal variation and trends in hospitalizations for AP in the USA with respect to AP etiology. METHODS The Nationwide Inpatient Sample data (2000-2016) from the Healthcare Cost and Utilization Project were used. The study population included all primary hospitalizations for AP. Biliary AP (BAP) and alcohol-induced AP (AAP) were distinguished by diagnostic and procedural ICD codes. Seasonal trend decomposition was performed. RESULTS There was a linear increase in annual incidence (per 100 000 population) of AAP in the USA (from 17.0 in 2000 to 22.9 in 2016), while incidence of BAP, equaled 19.9 in 2000, peaked at 22.1 in 2006 and decreased to 17.4 in 2016. AP incidence demonstrated 18% annual incidence amplitude with summer peak and winter trough, more prominent in AAP. In 2016, within AAP, the highest incidence (per 100 000 population) was noted among African-Americans (up to 50.4), followed by males aged 56-70 years (26.5) and Asians of low income (25.5); within BAP, above the average incidence was observed in Hispanic (up to 25.8) and Asian (up to 25.0) population. The most consistent and rapid increase in AP incidence was noted in males aged 56-70 years with an alcoholic etiology (average 6% annual incidence growth). CONCLUSIONS The incidence and annual trends of AP vary significantly among demographic and socioeconomic groups and this knowledge may be useful for the planning of healthcare resources and identification of at-risk populations.
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Affiliation(s)
- Artem Shmelev
- Department of Surgery, Saint Agnes Healthcare, Baltimore, MD, USA.
| | - Anne M Sill
- Department of Surgery, Saint Agnes Healthcare, Baltimore, MD, USA
| | - Tiffany Horrigan
- Department of Surgery, Saint Agnes Healthcare, Baltimore, MD, USA
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Kundumadam S, Fogel EL, Gromski MA. Gallstone pancreatitis: general clinical approach and the role of endoscopic retrograde cholangiopancreatography. Korean J Intern Med 2021; 36:25-31. [PMID: 33147903 PMCID: PMC7820643 DOI: 10.3904/kjim.2020.537] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/02/2020] [Indexed: 02/05/2023] Open
Abstract
Gallstones account for majority of acute pancreatitis in the Western world. Increase in number and smaller size of the stones increases the risk for biliary pancreatitis. In addition to features of acute pancreatitis, these patients also have cholestatic clinical picture. Fluid therapy and enteral nutrition are vital components in management of any case of acute pancreatitis. During initial evaluation, a right upper quadrant ultrasonogram is particularly important. On a case-bycase basis, further advanced imaging studies such as magnetic resonance cholangiopancreatography or endoscopic ultrasound may be warranted. Acute management also involves monitoring for local and systemic complications. Patients are triaged based on predictors of ongoing biliary obstruction in order to identify who would need endoscopic retrograde cholangiopancreatography. Index cholecystectomy is safe and recommended, with exception of cases with significant local and systemic complications where delayed cholecystectomy may be safer.
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Affiliation(s)
- Shanker Kundumadam
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Evan L. Fogel
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark Andrew Gromski
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
- Correspondence to Mark Andrew Gromski, M.D. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 550 N. University Blvd, Suite 1634, Indianapolis, IN 46202, USA Tel: +1-317-944-0925 Fax: +1-317-968-1265 E-mail:
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17
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Badal BD, Kruger AJ, Hart PA, Lara L, Papachristou GI, Mumtaz K, Hussan H, Conwell DL, Hinton A, Krishna SG. Predictors of hospital transfer and associated risks of mortality in acute pancreatitis. Pancreatology 2021; 21:25-30. [PMID: 33341342 DOI: 10.1016/j.pan.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 11/03/2020] [Accepted: 12/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is limited research in prognosticators of hospital transfer in acute pancreatitis (AP). Hence, we sought to determine the predictors of hospital transfer from small/medium-sized hospitals and outcomes following transfer to large acute-care hospitals. METHODS Using the 2010-2013 Nationwide Inpatient Sample (NIS), patients ≥18 years of age with a primary diagnosis of AP were identified. Hospital size was classified using standard NIS Definitions. Multivariable analyses were performed for predictors of "transfer-out" from small/medium-sized hospitals and mortality in large acute-care hospitals. RESULTS Among 381,818 patients admitted with AP to small/medium-sized hospitals, 13,947 (4%) were transferred out to another acute-care hospital. Multivariable analysis revealed that older patients (OR = 1.04; 95%CI 1.03-1.06), men (OR = 1.15; 95%CI 1.06-1.24), lower income quartiles (OR = 1.54; 95%CI 1.35-1.76), admission to a non-teaching hospital (OR = 3.38; 95%CI 3.00-3.80), gallstone pancreatitis (OR = 3.32; 95%CI 2.90-3.79), pancreatic surgery (OR = 3.14; 95%CI 1.76-5.58), and severe AP (OR = 3.07; 95%CI 2.78-3.38) were predictors of "transfer-out". ERCP (OR = 0.53; 95%CI 0.43-0.66) and cholecystectomy (OR = 0.14; 95%CI 0.12-0.18) were associated with decreased odds of "transfer-out". Among 507,619 patients admitted with AP to large hospitals, 31,058 (6.1%) were "transferred-in" from other hospitals. The mortality rate for patients "transferred-in" was higher than those directly admitted (2.54% vs. 0.91%, p < 0.001). Multivariable analysis revealed that being "transferred-in" from other hospitals was an independent predictor of mortality (OR = 1.47; 95% CI 1.22-1.77). CONCLUSIONS Patients with AP transferred into large acute-care hospitals had a higher mortality than those directly admitted likely secondary to more severe disease. Early implementation of published clinical guidelines, triage, and prompt transfer of high-risk patients may potentially offset these negative outcomes.
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Affiliation(s)
- Bryan D Badal
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Andrew J Kruger
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Luis Lara
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Georgious I Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Khalid Mumtaz
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Hisham Hussan
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Darwin L Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Somashekar G Krishna
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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18
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Blaszczak AM, Krishna SG, Hart PA, Bradley D, Hsueh W, Lara LF, Hussan H, Hinton A, Conwell DL, Cruz-Monserrate Z. Class III obesity rather than metabolic syndrome impacts clinical outcomes of acute pancreatitis: A propensity score weighted analysis. Pancreatology 2020; 20:1287-1295. [PMID: 32891531 PMCID: PMC7780090 DOI: 10.1016/j.pan.2020.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/23/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The incidence rates of acute pancreatitis (AP) and the prevalence of class III obesity, and metabolic syndrome (MetS) are increasing in the US. Since class III obesity was associated with adverse clinical outcomes of AP, we sought to understand if the presence of metabolic comorbidities collectively recognized, as MetS were associated with worse clinical outcomes and increased health-care utilization. METHODS The Nationwide Readmissions Database (NRD) (2010-2014) was reviewed to identify all adult subjects with a principal discharge diagnosis of AP. Inpatient mortality, severe AP (SAP), and 30-day readmissions were the primary outcomes analyzed. Propensity score weighted analyses were used to compare AP subjects with and without MetS and were further stratified by class III obesity status. RESULTS MetS was associated with 12.91% (139,165/1,078,183) of all admissions with AP. Propensity score weighted analyses showed that MetS was associated with an increased proportion of SAP (OR 1.21, 95% CI 1.17, 1.25), but decreased mortality (OR 0.62, 95% CI 0.54, 0.70) and 30-day readmissions (OR 0.86, 95% CI 0.83, 0.89). Propensity score weighted analyses also revealed that class III obesity was independently associated with increased mortality in AP subjects with (OR 1.92, 95% CI 1.41, 2.61) and without MetS (OR 1.55, 95% CI 1.26, 1.92), and increased SAP in subjects with and without MetS. CONCLUSIONS Class III obesity appears to be the primary factor associated with adverse clinical outcomes in subjects with MetS admitted with AP. This has significant implications for patient management and future research targeting AP.
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Affiliation(s)
- Alecia M. Blaszczak
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Somashekar G. Krishna
- Division of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA,The Comprehensive Cancer Center–Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA
| | - Phil A. Hart
- Division of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA,The Comprehensive Cancer Center–Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA
| | - David Bradley
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Willa Hsueh
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Luis F. Lara
- Division of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA,The Comprehensive Cancer Center–Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA
| | - Hisham Hussan
- Division of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA,The Comprehensive Cancer Center–Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, 43210, USA
| | - Darwin L. Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA,The Comprehensive Cancer Center–Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA
| | - Zobeida Cruz-Monserrate
- Division of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA,The Comprehensive Cancer Center–Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA
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19
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Gao B, Zhang X, Xue D, Zhang W. Effects of Egr1 on pancreatic acinar intracellular trypsinogen activation and the associated ceRNA network. Mol Med Rep 2020; 22:2496-2506. [PMID: 32705196 PMCID: PMC7411386 DOI: 10.3892/mmr.2020.11316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/08/2020] [Indexed: 12/13/2022] Open
Abstract
Acute pancreatitis (AP) is a common digestive disorder with high morbidity and mortality. The present study aimed to investigate the expression of early growth response protein 1 (Egr1), and the effect of competing endogenous (ce)RNA network on trypsinogen activation. Pancreatic acinar intracellular trypsinogen activation (PAITA) is an important event in the early stage of AP; however, the underlying mechanisms remain unclear. The present study used taurolithocholic acid 3-sulfate (TLC-S)-treated AR42J cells (pancreatic cell line) to establish a PAITA model. A gene microarray and bioinformatics analysis was performed to identify the potential key targets in PAITA. The results demonstrated that Egr1, an important transcription factor, was significantly overexpressed in PAITA. In Egr1 small interfering (si)RNA-transfected cells, Egr1 expression was decreased and trypsinogen activation was significantly decreased compared with negative control siRNA-transfected cells, indicating that in TLC-S-induced PAITA, overexpression of Egr1 enhanced trypsinogen activation. A ceRNA network [mRNA-microRNA (miRNA/miR)-long non-coding (lnc)RNA] generated using the PAITA model revealed that the effects of Egr1 on PAITA may be regulated by multiple ceRNA pairs, and the lncRNAs (including NONRATT022624 and NONRATT031002) and miRNAs [including Rattus norvegicus (rno)-miR-214-3p and rno-miR-764-5p] included in the ceRNA pairs may serve roles in PAITA by regulating the expression of Egr1. The results of the present study may provide novel targets for researching the underlying mechanisms of, and developing treatments for AP.
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Affiliation(s)
- Bo Gao
- Department of General Surgery, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Xueming Zhang
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 100086, P.R. China
| | - Dongbo Xue
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 100086, P.R. China
| | - Weihui Zhang
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 100086, P.R. China
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20
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Bergeron E, Desilets E, Maniere T, Bensoussan M. Same-day endoscopic ultrasound, retrograde cholangiopancreatography and stone extraction, followed by cholecystectomy: A case report and literature review. Int J Surg Case Rep 2020; 70:115-118. [PMID: 32416480 PMCID: PMC7229231 DOI: 10.1016/j.ijscr.2020.04.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/06/2020] [Accepted: 04/21/2020] [Indexed: 12/07/2022] Open
Abstract
The risk of recurrence or complications is high after a common bile duct stone related event. Cholecystectomy should be carried out soon after extraction of a common bile duct stone. Same-day investigation, endoscopic stone extraction and cholecystectomy is feasible and safe.
Introduction Common bile duct stone-related events and their recurrence are frequent even after endoscopic retrograde cholangiopancreatography and stone extraction. Cholecystectomy should be carried out as soon as possible after the initial episode to prevent complications. Case presentation We present a case of a patient who underwent endoscopic ultrasound, cholangiopancreatography with stone extraction and cholecystectomy on the same day. Discussion After a common bile duct stone-related event, investigation, and stone extraction, cholecystectomy should be carried out as soon as possible to avoid high rates of recurrence and complications. Rise in health care costs nowadays mandate such an approach as a pre-emptive measure to prevent health complications while lowering health costs. Conclusion Diagnosis of common bile duct stone followed by extraction with endoscopic cholangiopancreatography and cholecystectomy on the same day is feasible, safe, and has many potential advantages.
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Affiliation(s)
- Eric Bergeron
- Departments of Surgery and Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, Canada.
| | - Etienne Desilets
- Departments of Surgery and Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, Canada
| | - Thibaut Maniere
- Departments of Surgery and Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, Canada
| | - Michael Bensoussan
- Departments of Surgery and Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, Canada
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21
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Patel KP, Mumtaz K, Li F, Luthra AK, Hinton A, Lara LF, Conwell DL, Krishna SG. Index admission cholecystectomy for acute biliary pancreatitis favorably impacts outcomes of hospitalization in cirrhosis. J Gastroenterol Hepatol 2020; 35:284-290. [PMID: 31264249 DOI: 10.1111/jgh.14775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/20/2019] [Accepted: 06/26/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Despite higher rates of gallstones in patients with cirrhosis, there are no population-based studies evaluating outcomes of acute biliary pancreatitis (ABP). Therefore, we sought to evaluate the predictors of early readmission and mortality in this high-risk population. METHODS We utilized the Nationwide Readmission Database (2011-2014) to evaluate all adults admitted with ABP. Multivariable logistic regression models were used to assess independent predictors for 30-day readmission, index admission mortality, and calendar year mortality. RESULTS Among 184 611 index admissions with ABP, 4344 (2.4%) subjects had cirrhosis (1649 with decompensation). Subjects with cirrhosis, when compared with those without, incurred higher rates of 30-day readmission (20.9% vs 11.2%; P < 0.001), index mortality (2.0% vs 1.0%; P < 0.001), and calendar year mortality (4.2% vs 0.9%; P < 0.001). Decompensation in cirrhosis was associated with significantly fewer cholecystectomies (26.7% vs 60.2%; P < 0.001) and endoscopic retrograde cholangiopancreatographies (23.3% vs 29.9%; P < 0.001). Multivariate analysis revealed that severe acute pancreatitis (odds ratio [OR]: 14.8; 95% confidence interval [CI]: 5.3, 41.2), sepsis (OR: 12.6; 95% CI: 5.8, 27.4), and decompensation (OR: 3.1; 96% CI: 1.4, 6.6) were associated with increased index admission mortality. Decompensated cirrhosis (OR: 1.8; 95% CI: 1.1, 3.0) and 30-day readmission (OR: 5.6; 95% CI: 3.3, 9.5) were predictors of calendar year mortality. However, index admission cholecystectomy was associated with decreased 30-day readmissions (OR: 0.6; 95% CI: 0.4, 0.7) and calendar year mortality (OR: 0.44; 95% CI: 0.25, 0.78). CONCLUSIONS The presence of cirrhosis adversely impacts hospital outcomes of patients with ABP. Among modifiable factors, index admission cholecystectomy portends favorable prognosis by reducing risk of early readmission and consequent calendar year mortality.
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Affiliation(s)
- Kishan P Patel
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Khalid Mumtaz
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Feng Li
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Anjuli K Luthra
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Luis F Lara
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Darwin L Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Somashekar G Krishna
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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22
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Zhang X, Gao B, Huang Y, Zhang Y, Li Z, Zhao D, Ma B, Xue D, Zhang W. miR‑92a‑3p regulates trypsinogen activation via Egr1 in AR42J cells. Mol Med Rep 2019; 20:4140-4150. [PMID: 31545429 PMCID: PMC6797994 DOI: 10.3892/mmr.2019.10673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 07/15/2019] [Indexed: 12/29/2022] Open
Abstract
Acute pancreatitis (AP) exhibits high morbidity and mortality rates. The onset of AP is characterized by early trypsinogen activation. The present study aimed to investigate the expression of microRNA (miR)-92a-3p and early growth response protein 1 (Egr1), and the effect of miR-92a-3p on trypsinogen activation in the pancreatic exocrine cell line AR42J. mRNA and miRNA microarrays were used to identify differentially expressed mRNAs and miRNAs in AR42J cells. A miRNA-mRNA network was constructed using bioinformatics software, and Egr1 and its regulated miRNA subnetworks were identified by reviewing previous literature. The results suggested that miR-92a-3p could bind to Egr1 3′untranslated region sequence. Subsequently, miR-92a-3p mimic and inhibitor were used to transfect AR42J cells. Following transfection, reverse transcription-quantitative PCR and western blotting were performed to detect Egr1 expression. Furthermore, AR42J cells were cotransfected with miR-92a-3p inhibitor and small interfering (si)-Egr1. The trypsinogen activation rate of AR42J cells was measured by flow cytometry. Microarrays and bioinformatics results indicated that Egr1 may be a target gene of miR-92a-3p. In addition, the present study suggested that miR-92a-3p downregulated Egr1 in vitro and that miR-92a-3p and Egr1 expression was associated with trypsinogen activation. Furthermore, miR-92a-3p inhibitor reversed the effect of si-Egr1 on trypsinogen activation. In conclusion, miR-92a-3p may negatively regulate the activation of trypsinogen in AR42J cells via Egr1.
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Affiliation(s)
- Xueming Zhang
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Bo Gao
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Yang Huang
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Yong Zhang
- Department of Hepatopancreatobiliary Surgery, Weifang Traditional Chinese Medicine Hospital, Weifang, Shandong 261041, P.R. China
| | - Zhituo Li
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Dali Zhao
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Biao Ma
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Dongbo Xue
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Weihui Zhang
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
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Acute Pancreatitis Task Force on Quality: Development of Quality Indicators for Acute Pancreatitis Management. Am J Gastroenterol 2019; 114:1322-1342. [PMID: 31205135 DOI: 10.14309/ajg.0000000000000264] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Detailed recommendations and guidelines for acute pancreatitis (AP) management currently exist. However, quality indicators (QIs) are required to measure performance in health care. The goal of the Acute Pancreatitis Task Force on Quality was to formally develop QIs for the management of patients with known or suspected AP using a modified version of the RAND/UCLA Appropriateness Methodology. METHODS A multidisciplinary expert panel composed of physicians (gastroenterologists, hospitalists, and surgeons) who are acknowledged leaders in their specialties and who represent geographic and practice setting diversity was convened. A literature review was conducted, and a list of proposed QIs was developed. In 3 rounds, panelists reviewed literature, modified QIs, and rated them on the basis of scientific evidence, bias, interpretability, validity, necessity, and proposed performance targets. RESULTS Supporting literature and a list of 71 proposed QIs across 10 AP domains (Diagnosis, Etiology, Initial Assessment and Risk Stratification, etc.) were sent to the expert panel to review and independently rate in round 1 (95% of panelists participated). Based on a round 2 face-to-face discussion of QIs (75% participation), 41 QIs were classified as valid. During round 3 (90% participation), panelists rated the 41 valid QIs for necessity and proposed performance thresholds. The final classification determined that 40 QIs were both valid and necessary. DISCUSSION Hospitals and providers managing patients with known or suspected AP should ensure that patients receive high-quality care and desired outcomes according to current evidence-based best practices. This physician-led initiative formally developed 40 QIs and performance threshold targets for AP management. Validated QIs provide a dependable quantitative framework for health systems to monitor the quality of care provided to patients with known or suspected AP.
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24
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Bilal M, Kline KT, Trieu JA, Saraireh H, Desai M, Parupudi S, Abougergi MS. Trends in same-admission cholecystectomy and endoscopic retrograde cholangiopancreatography for acute gallstone pancreatitis: A nationwide analysis across a decade. Pancreatology 2019; 19:524-530. [PMID: 31036491 DOI: 10.1016/j.pan.2019.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/05/2019] [Accepted: 04/18/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Gallstones are the leading cause of acute pancreatitis in developed countries. National and international guidelines recommend that a cholecystectomy should be performed during the index hospitalization for acute gallstone pancreatitis. We aimed to delineate the national trends for same-admission cholecystectomy and ERCP for acute gallstone pancreatitis over the last ten years. METHODS We used the 2004, 2009 and 2014 National Inpatient Sample database including patients with a principal diagnosis of acute pancreatitis and a secondary diagnosis of choledocholithiasis or cholelithiasis. Exclusion criteria were age <18 years and elective admission. Primary outcome was the trend in incidence rate of same admission cholecystectomy from 2004 to 2014. The secondary outcomes were: 10-year trend in 1) Incidence of gallstone pancreatitis, 2) proportion of gallstone pancreatitis compared to all other etiologies of acute pancreatitis, 3) incidence rate of same-admission ERCP, 4) length of hospital stay, and 5) total hospitalization costs and charges. RESULTS The proportion of admissions during which a same-admission cholecystectomy was performed decreased from 48.7% in 2004 to 46.9% in 2009 to 45% in 2014 (trend p < 0.01). During the same time interval, the percentage of admissions during which an ERCP was performed decreased from 25.1% to 18.7% (Trend p < 0.01). CONCLUSIONS Adherence to the guidelines for same-admission cholecystectomy for patients admitted with acute gallstone pancreatitis have been declining over the past decade. On the other hand, decline in rate of ERCP in patients with acute gallstone pancreatitis and no signs of cholangitis demonstrates adherence to guidelines in this regard.
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Affiliation(s)
- Mohammad Bilal
- Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, Galveston, TX, USA.
| | - Kevin T Kline
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Judy A Trieu
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Hamzeh Saraireh
- Division of Gastroenterology & Hepatology, Virginia Commonwealth University, Richmond, VA, USA
| | - Madhav Desai
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Sreeram Parupudi
- Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Marwan S Abougergi
- Catalyst Medical Consulting, Simpsonville, SC, USA; University of South Carolina School of Medicine, Columbia, SC, USA
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