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Firkins SA, Chittajallu V, Flora B, Yoo H, Simons-Linares R. Utilization of Anti-obesity Medications After Bariatric Surgery: Analysis of a Large National Database. Obes Surg 2024; 34:1415-1424. [PMID: 38512645 DOI: 10.1007/s11695-024-07181-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE A significant proportion of patients experience insufficient weight loss or weight regain after bariatric surgery. There is a paucity of literature describing anti-obesity medication (AOM) use following bariatric surgery. We sought to identify prevalence and trends of AOM use following bariatric surgery. MATERIALS AND METHODS We utilized the IBM Explorys® database to identify all adults with prior bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy). Those prescribed AOMs (semaglutide, liraglutide, topiramate, phentermine/topiramate, naltrexone/bupropion, orlistat) within 5 years of surgery were further identified. Data was analyzed to characterize AOM utilization among different age, demographic, and comorbid populations. RESULTS A total of 59,160 adults with prior bariatric surgery were included. Among AOMs studies, prevalence of use was highest for topiramate (8%), followed by liraglutide (2.9%), phentermine/topiramate (1.03%), naltrexone/bupropion (0.95%) semaglutide (0.52%), and orlistat (0.17%). Age distribution varied, with the highest utilization among those age 35-39 years for topiramate, 40-44 years for phentermine/topiramate and naltrexone/bupropion, 45-49 years for semaglutide, and 65-69 years for liraglutide and orlistat. African American race was associated with higher utilization across all AOMs. Among comorbidities, hypertension, hyperlipidemia, and diabetes mellitus were most associated with AOM use. CONCLUSION Despite a relatively high incidence of weight regain, AOMs are underutilized following bariatric surgery. It is imperative that barriers to their use be addressed and that AOMs be considered earlier and more frequently in patients with insufficient weight loss or weight regain after bariatric surgery.
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Affiliation(s)
- Stephen A Firkins
- Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Vibhu Chittajallu
- Digestive Health Institute, University Hospitals, Cleveland, OH, USA
| | - Bailey Flora
- Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Heesoo Yoo
- Community Care Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Roberto Simons-Linares
- Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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Sandoval V, Chittajallu V, Haddad FG. An Endoscopic Illusion! ACG Case Rep J 2024; 11:e01278. [PMID: 38501035 PMCID: PMC10948130 DOI: 10.14309/crj.0000000000001278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/15/2024] [Indexed: 03/20/2024] Open
Affiliation(s)
- Victoria Sandoval
- Department of Internal Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Vibhu Chittajallu
- Department of Gastroenterology and Hepatology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Fady G. Haddad
- Department of Gastroenterology and Hepatology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH
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Chittajallu V, Mansoor E, Perez J, Omar YA, Firkins SA, Yoo H, Baggott B, Simons-Linares R. Association of Bariatric Surgery with Risk of Incident Obesity-Associated Malignancies: a Multi-center Population-Based Study. Obes Surg 2023; 33:4065-4069. [PMID: 37971573 DOI: 10.1007/s11695-023-06926-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 10/15/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Obesity has a known association with certain types of malignancy, and we aimed to determine whether bariatric surgery has a protective effect against de novo obesity-associated cancer development in adult patients. METHODS We performed a multi-center retrospective cohort studying utilizing TriNetX national database. Patients were identified utilizing ICD-10-CM coding, and propensity score matching was performed. We compared patients with obesity who underwent bariatric surgery to patients with obesity who did not undergo bariatric surgery. RESULTS We initially identified 60,285 patients in the bariatric surgery group and 1,570,440 patients in nonsurgical control group. After propensity score matching, we included 55,789 patients in each patient cohort. The cumulative incidence of de novo obesity-associated cancers at 10 years was 4.0% (2206 patients) in the bariatric surgery group and 8.9% (4,960 patients) in the nonsurgical control group (HR 0.482 [95% CI 0.459-0.507]). The bariatric surgery group had lower incidence proportions for de novo breast cancer (HR 0.753 [CI 0.678-0.836]), colon cancer (HR 0.638 [CI 0.541-0.752]), liver cancer (HR 0.370 [CI 0.345-0.396]), ovarian cancer (HR 0.654 [CI 0.531-0.806]), and endometrial cancer (HR 0.448 [CI 0.362-0.556]) when compared to the nonsurgical control group. CONCLUSION We noted that bariatric surgery is associated with a significantly lower cumulative incidence of de novo obesity-associated cancer compared to a nonsurgical matched control group. Incidence proportions of de novo breast, colon, liver, ovarian, and endometrial cancer were significantly lower in adult patients with obesity in the bariatric surgery group compared to the nonsurgical group.
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Affiliation(s)
- Vibhu Chittajallu
- Digestive Health Institute, University Hospitals, Cleveland, OH, USA
| | - Emad Mansoor
- Digestive Health Institute, University Hospitals, Cleveland, OH, USA
| | - Jaime Perez
- Digestive Health Institute, University Hospitals, Cleveland, OH, USA
| | | | | | - Heesoo Yoo
- Cleveland Clinic Foundation, Cleveland, OH, USA
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Naami R, Tashtish N, Neeland IJ, Katz J, Sinh P, Nasir K, Chittajallu V, Mansoor E, Rajagopalan S, Al-Kindi S. Coronary artery calcium scoring for cardiovascular risk assessment in patients with inflammatory bowel disease. Am Heart J 2023; 266:120-127. [PMID: 37634654 DOI: 10.1016/j.ahj.2023.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is associated with higher incidence of atherosclerotic cardiovascular disease (ASCVD). Data investigating the role of coronary artery calcium (CAC) scoring in identifying subclinical atherosclerotic disease in IBD patients is scarce. METHODS Using data obtained from the CLARIFY registry, a prospective study of no-charge coronary artery calcium (CAC) testing at University Hospitals, we reviewed patients with ulcerative colitis (UC) or Crohn's disease (CD) who underwent CAC scoring from 2014 to 2020. We investigated the concordance between CAC risk and 10-year estimated ASCVD risk by AHA/ACC pooled cohort equation using pre-established thresholds for statin prescription (CAC≥100, 10-year ASCVD risk ≥7.5%). We additionally investigated the association between CAC, preventive therapy initiation and Major Adverse Cardiovascular Events (MACE). RESULTS A total of 369 patients with IBD were included (174 UC, 195 CD), with median age of 60 years. The median CAC score was 14.9 with no significant difference between UC and CD (P = .76). Overall, 151 (41%) had CAC of 0, 108 (29%) had CAC 1-99, 61 (17%) had CAC 100 to 399, and 49 (13%) had CAC ≥400 with no difference in CAC distribution between CD and UC (P = .17). There was no difference in median CAC between IBD or age/sex-matched controls (P = .34). Approximately half of the patients (52%) with IBD had 10-year estimated ASCVD risk of 7.5% or higher. Among patients with ASCVD risk <7.5% (n = 163), 29 (18%) had CAC≥100 and among patients with ASCVD risk ≥7.5% (n = 178), 102 (57%) had CAC <100. There was no difference between CAC<100 vs CAC≥100 with respect to CRP, use of immunosuppressive or amino-salicylate therapy, IBD severity or complications. CAC score (AUROC 0.67 [0.56-0.78]), but not PCE ASCVD risk (AUROC 0.60 [0.48-0.73]), was predictive of MACE. The best cut-off for CAC score was 76 (sensitivity = 60%, specificity = 69%), and was associated with 4-fold increase in MACE (Hazard Ratio 4.0 [2.0-8.1], P < .001). CONCLUSION Subclinical atherosclerosis, as evaluated by CAC scoring, is prevalent in patients with IBD, and is associated with cardiovascular events. Further studies are needed to understand underlying biological processes of increased atherosclerotic disease risk among adults with IBD.
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Affiliation(s)
- Robert Naami
- Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Nour Tashtish
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH
| | - Ian J Neeland
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH
| | - Jeffry Katz
- Digestive Health Institute, University Hospitals, Cleveland, OH
| | - Preetika Sinh
- Division of Gastroenterology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX
| | | | - Emad Mansoor
- Digestive Health Institute, University Hospitals, Cleveland, OH
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH
| | - Sadeer Al-Kindi
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX.
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Kumar P, Chander A, Chittajallu V, Grewal US. Underutilization of pancreatic enzyme replacement therapy in pancreatic cancer and chronic pancreatitis. J Intern Med 2023; 294:679-681. [PMID: 37264522 DOI: 10.1111/joim.13671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Prabhat Kumar
- Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, Ohio, USA
| | - Apoorva Chander
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Vibhu Chittajallu
- Department of Gastroenterology and Hepatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Udhayvir Singh Grewal
- Division of Hematology, Oncology, Bone and Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Holden Comprehensive Cancer Center, Iowa City, Iowa, USA
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6
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Maselli DB, Chittajallu V, Wooley C, Waseem A, Lee D, Secic M, Donnangelo LL, Coan B, McGowan CE. Transoral outlet reduction: Outcomes of endoscopic Roux-en-Y gastric bypass revision in 284 patients at a community practice. World J Gastrointest Endosc 2023; 15:602-613. [PMID: 37900116 PMCID: PMC10600692 DOI: 10.4253/wjge.v15.i10.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Transoral outlet reduction (TORe) is a minimally invasive endoscopic revision of Roux-en-Y gastric bypass (RYGB) for weight recurrence; however, little has been published on its clinical implementation in the community setting. AIM To characterize the safety and efficacy of TORe in the community setting for adults with weight recurrence after RYGB. METHODS This is a retrospective cohort study of argon plasma coagulation and purse-string suturing for gastric outlet reduction in consecutive adults with weight recurrence after RYGB at a single community center from September 2020 to September 2022. Patients were provided longitudinal nutritional support via virtual visits. The primary outcome was total body weight loss (TBWL) at twelve months from TORe. Secondary outcomes included TBWL at three months and six months; excess weight loss (EWL) at three, six, and twelve months; twelve-month TBWL by obesity class; predictors of twelve-month TBWL; rates of post-TORe stenosis; and serious adverse events (SAE). Outcomes were reported with descriptive statistics. RESULTS Two hundred eighty-four adults (91.9% female, age 51.3 years, body mass index 39.3 kg/m2) underwent TORe an average of 13.3 years after RYGB. Median pre- and post-TORe outlet diameter was 35 mm and 8 mm, respectively. TBWL was 11.7% ± 4.6% at three months, 14.3% ± 6.3% at six months, and 17.3% ± 7.9% at twelve months. EWL was 38.4% ± 28.2% at three months, 46.5% ± 35.4% at six months, and 53.5% ± 39.2% at twelve months. The number of follow-up visits attended was the strongest predictor of TBWL at twelve months (R2 = 0.0139, P = 0.0005). Outlet stenosis occurred in 11 patients (3.9%) and was successfully managed with endoscopic dilation. There was one instance of post-procedural nausea requiring overnight observation (SAE rate 0.4%). CONCLUSION When performed by an experienced endoscopist and combined with longitudinal nutritional support, purse-string TORe is safe and effective in the community setting for adults with weight recurrence after RYGB.
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Affiliation(s)
- Daniel B Maselli
- Clinical Research, True You Weight Loss, Atlanta, GA 30342, United States
| | - Vibhu Chittajallu
- Department of Gastroenterology and Hepatology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States
| | - Chase Wooley
- Clinical Research, True You Weight Loss, Cary, NC 27513, United States
| | - Areebah Waseem
- Clinical Research, True You Weight Loss, Cary, NC 27513, United States
| | - Daniel Lee
- Clinical Research, True You Weight Loss, Cary, NC 27513, United States
| | - Michelle Secic
- Secic Statistical Consulting, Cleveland, OH 44106, United States
| | | | - Brian Coan
- Clinical Research, True You Weight Loss, Cary, NC 27513, United States
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Ford A, Chittajallu V, Abraham Perez J, Martin S, Alkhayyat M, Dave M, Ho EY, Sinh P, Nguyen V, Cooper G, Katz J, Cominelli F, Regueiro M, Mansoor E. Prevalence Rates of Pneumococcal Vaccination in IBD and 30-Day Clinical Outcomes in Patients With IBD and Pneumococcal Disease Stratified by Receipt of Pneumococcal Vaccination: A Multi-Network Study. Crohns Colitis 360 2023; 5:otad048. [PMID: 38077746 PMCID: PMC10708920 DOI: 10.1093/crocol/otad048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Lay Summary
This study sought to assess outcomes associated with pneumococcal vaccination in adult inflammatory bowel disease patients. Results found unvaccinated patients had higher adverse outcomes, including greater risk of hospitalization, ICU admission, ventilation, and mortality. These findings underscore the importance of pneumococcal vaccination.
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Affiliation(s)
- Andrew Ford
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Vibhu Chittajallu
- Digestive Health Institute, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jaime Abraham Perez
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Scott Martin
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Motasem Alkhayyat
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Maneesh Dave
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, UC Davis Medical Center, UC Davis School of Medicine, Sacramento, CA, USA
| | - Edith Y Ho
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Preetika Sinh
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Vu Nguyen
- Digestive Health Institute, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Gregory Cooper
- Digestive Health Institute, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jeffry Katz
- Digestive Health Institute, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Fabio Cominelli
- Digestive Health Institute, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Emad Mansoor
- Digestive Health Institute, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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8
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Khurana AT, Chittajallu V, Reed S, Sutter C, Glessing B. Lumbar Artery Pseudoaneurysms Presenting as a Novel Complication of Severe, Necrotizing Pancreatitis. ACG Case Rep J 2023; 10:e01129. [PMID: 37621303 PMCID: PMC10445782 DOI: 10.14309/crj.0000000000001129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023] Open
Abstract
Splanchnic artery pseudoaneurysms are a known complication of necrotizing pancreatitis. Lumbar artery pseudoaneurysms are rare and usually associated with trauma, renal biopsy, or spinal procedures. We present a rare case of lumbar artery pseudoaneurysms as a complication of necrotizing pancreatitis. A 55-year-old man initially presented with necrotizing biliary pancreatitis complicated by peripancreatic necrotic fluid collections and walled-off necrosis requiring multiple endoscopic ultrasound-guided necrosectomies. Inferoposterior extension of collections to the retroperitoneum caused lumbar artery pseudoaneurysms, leading to hemorrhagic shock from retroperitoneal and intraperitoneal hemorrhages.
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Affiliation(s)
- Akash T. Khurana
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
- Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Vibhu Chittajallu
- Department of Medicine, Case Western Reserve University, Cleveland, OH
- Digestive Health Institute, University of Hospitals Cleveland Medical Center, Cleveland, OH
| | - Steven Reed
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Christopher Sutter
- Department of Medicine, Case Western Reserve University, Cleveland, OH
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Brooke Glessing
- Department of Medicine, Case Western Reserve University, Cleveland, OH
- Digestive Health Institute, University of Hospitals Cleveland Medical Center, Cleveland, OH
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9
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Chittajallu V, Omar YA, Simons-Linares CR, Chahal P. Endoscopic balloon dilation management for benign duodenal stenosis. Surg Endosc 2023; 37:3610-3618. [PMID: 36624215 DOI: 10.1007/s00464-022-09844-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Benign duodenal stenosis (BDS) is most commonly caused by peptic ulcer disease (PUD). Endoscopic balloon dilation (EBD) is the recommended initial management despite limited supporting literature. Our study investigated the etiologic spectrum of BDS and its response to endoscopic dilation. METHODS We performed a cohort study of a prospectively maintained database of BDS at our large tertiary academic center between 2002 and 2018. All patients who underwent EBD were analyzed. Dilation was performed using through-the-scope balloons. Technical and clinical successes of initial and repeat EBD were compared. Descriptive statistics, univariate, and multivariate analysis were performed. RESULTS The study included 86 patients with 54.7% female gender. Etiologies included 39 patients with PUD (45.3%), 19 patients with Crohn's disease (22.1%), 23 patients had idiopathic etiologies (26.7%), and 5 patients were listed as other etiologies (5.8%). Proximal stricture location (1st part of duodenum) occurred in 66% of females, whereas distal duodenal involvement was seen in 63.6% of males (p value 0.007). Usage of PPI was associated with 3.6 times higher clinical success rate (p value 0.04). Technical (97.4%) and clinical (77.8%) successes for index dilations in PUD were not significantly better than those of non-PUD patients (p values 0.99, 0.52). CONCLUSION EBD has both a high technical and clinical success for BDS regardless of etiology and should be considered over initial surgical intervention due to low risk profile. Males tend to have more distal duodenal involvement, and PPI usage is an independent predictor for clinical success.
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Affiliation(s)
- Vibhu Chittajallu
- Digestive Health Institute, University Hospitals Cleveland, Cleveland, OH, USA.
| | - Yazan Abu Omar
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Prabhleen Chahal
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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10
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Simons-Linares CR, Chittajallu V, Chahal P. Stent gone rogue: endoscopic removal of a 3-year-old embedded cystogastrostomy stent. VideoGIE 2020; 5:548-551. [PMID: 33204913 PMCID: PMC7650305 DOI: 10.1016/j.vgie.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- C Roberto Simons-Linares
- Gastroenterology and Hepatology Department, Digestive Disease and Surgery Institute Cleveland Clinic Foundation, Cleveland, Ohio
| | - Vibhu Chittajallu
- Gastroenterology and Hepatology Department, Digestive Disease and Surgery Institute Cleveland Clinic Foundation, Cleveland, Ohio
| | - Prabhleen Chahal
- Gastroenterology and Hepatology Department, Digestive Disease and Surgery Institute Cleveland Clinic Foundation, Cleveland, Ohio
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11
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Parikh MP, Garg R, Chittajallu V, Gupta N, Sarvepalli S, Lopez R, Thota PN, Siddiki H, Bhatt A, Chahal P, Jang S, Stevens T, Vargo J, McCullough A, Sanaka MR. Trends and risk factors for 30-day readmissions in patients with acute cholangitis: analysis from the national readmission database. Surg Endosc 2020; 35:223-231. [PMID: 31950275 DOI: 10.1007/s00464-020-07384-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/08/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Acute cholangitis (AC) can be associated with significant mortality and high risk of readmissions, if not managed promptly. We used national readmission database (NRD) to identify trends and risk factors associated with 30-day readmissions in patients with AC. METHODS We conducted a retrospective cohort study of adult patients admitted with AC from 2010-2014 and Q1-Q3 of 2015 by extracting data from NRD. Initial admission with a primary diagnosis of acute cholangitis (ICD-9 code: 576.1) was considered as the index admission and any admission after index admission was considered a readmission regardless of the primary diagnosis. Multivariable regression analyses were performed to assess the association. RESULTS From 52,906 AC index admissions, overall 30-day readmission rate was 21.48% without significant differences in the readmission rates across the study period. There was significant increase in the overall hospital charges for readmissions, while a significant reduction in the death rate was observed during the first readmission. Recurrent cholangitis (14%), septicemia (6.4%), and mechanical complication of bile duct prosthesis (3%) were the most common reasons for readmissions. The risk of readmission was significantly higher in patients with pancreatic neoplasm (OR 1.6, 95% CI 1.4-1.8), those who underwent percutaneous biliary procedures (OR 1.4, 95% CI 1.2-1.6), and who had an acute respiratory failure (OR 1.2, 95% CI 1.0-1.15). Other factors contributing to increased risk of readmissions included patients with Charleston comorbidity index > 3, diabetes, and length of stay > 3 days. Readmission risk was significantly lower in patients who underwent ERCP (OR 0.80, 95% CI 0.73-0.88) or cholecystectomy (OR 0.54, 95% CI 0.43-0.69). CONCLUSIONS AC is associated with a high 30-day readmission rate of over 21%. Patients with malignant biliary obstruction, increased comorbidities, and those who undergo percutaneous drainage rather than ERCP seem to be at the highest risk.
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Affiliation(s)
- Malav P Parikh
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Rajat Garg
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Vibhu Chittajallu
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Niyati Gupta
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Shashank Sarvepalli
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Rocio Lopez
- Department of Biostatistics and Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, USA
| | - Prashanthi N Thota
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - Hassan Siddiki
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - Amit Bhatt
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - Prabhleen Chahal
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - Tyler Stevens
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - John Vargo
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - Arthur McCullough
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - Madhusudhan R Sanaka
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA. .,Department of Gastroenterolgy, Cleveland Clinic Foundation, Desk Q39500 Euclid Avenue, Cleveland, OH, 44195, USA.
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