Cholecystectomy Reduces the Odds of Inpatient Mortality in Patients With Acute Biliary Pancreatitis

Introduction: Acute biliary pancreatitis (ABP) is a frequent cause of acute pancreatitis, comprising approximately one-third of all cases. When ABP is complicated by necrosis, mortality significantly increases. Performing a cholecystectomy (CCY) on the same admission in the presence of necrosis is controversial. We hypothesize that in patients with ABP with necrosis, CCY during hospitalization reduces mortality. Methods: A retrospective cohort study using the 2017-2020 National Inpatient Sample database was performed. The ICD 10th Revision was used to identify patients diagnosed with ABP with necrosis. Patients < 18 years of age were excluded. Patients who met the inclusion criteria were divided into patients who died while hospitalized and patients who did not die. Univariate analysis using the Chi-Square test was performed. Multivariate analysis was performed using a binary logistic regression model. Inpatient mortality was used as the dependent variable. Independent variables included race, age, gender, household income quartile, expected payer, region, year of admission and whether CCY was performed during the admission. Results: A total of 2638 patients met the inclusion criteria. 2474 (93.8%) were discharged alive and 164 (6.2%) died during the hospitalization. Demographic characteristics are shown in Table 1. Univariate analysis showed that age (P< 0.01), race (P=0.01), gender (P< 0.01), expected payer (P< 0.01), household income (P=0.02) and CCY during admission (P< 0.01) were associated with inpatient mortality. On adjusted multivariate analysis, age groups 41-64 (OR=5.27, 95% CI 2.21-12.6), 65-79 (OR=9.63, 95% CI 3.69-25.18) and 80+ years (OR=15.02, 95% CI 5.31-42.51) had higher odds of dying than patients aged 18-40 years. Patients residing in a zip code with an average household income in Quartile 1 (OR=2.32, 95% CI 1.32-4.09) and Quartile 2 OR=2.24, 95% CI 1.28-3.93,) had higher odds of dying than patients residing in a zip code in the highest quartile of average household income (Quartile 4). Finally, patients who underwent CCY during admission had lower odds of inpatient death (OR=0.40, 95% CI 0.24-0.27) than patients who did not undergo CCY. Conclusion: Performing a CCY in ABP with necrosis during the same hospitalization remains controversial. Our data suggests that CCY performed on the same admission reduces the odds of inpatient mortality. CCY on the same admission may be considered for some ABP patients with concomitant necrosis. Table 1. - Odds of inpatient death by multivariate logistic regression OR 95% CI P value Lower Upper Race White (reference) 0.43 Black 0.63 0.31 1.29 0.21 Hispanic 0.54 0.28 1.04 0.06 Asian or Pacific Islander 0.68 0.20 2.26 0.53 Native American 0.87 0.18 4.16 0.86 Other 0.78 0.30 2.04 0.62 Age (Years) 18-40 (reference) < .01 41-64 5.27 2.21 12.60 < .01 65-79 9.63 3.69 25.18 < .01 80+ 15.022 5.31 42.51 < .01 Gender Male (reference) Female 0.74 0.51 1.05 0.09 Income Groups ($) Quartile 4 (reference) < 0.01 Quartile 3 1.39 0.78 2.50 0.27 Quartile 2 2.24 1.28 3.93 < 0.01 Quartile 1 2.32 1.32 4.09 < 0.01 Region New England (reference) 0.64 Middle Atlantic 0.89 0.32 2.48 0.83 East North Central 0.96 0.37 2.51 0.94 West North Central 1.48 0.54 4.05 0.45 South Atlantic 1.48 0.59 3.68 0.40 East South Central 1.68 0.59 4.75 0.33 West South Central 1.27 0.46 3.50 0.64 Mountain 0.99 0.31 3.14 0.99 Pacific 1.52 0.58 3.99 0.39 Weekday vs Weekend Admission Admitted on Weekday (reference) Admitted on Weekend 0.84 0.56 1.27 0.41 Expected Payer Private Insurance 0.99 Medicare 1.00 0.58 1.73 1.00 Medicaid 0.78 0.36 1.69 0.53 Self-Pay 1.03 0.38 2.76 0.96 No Charge 0.00 0.00 . 1.00 Other 1.01 0.33 3.05 0.99 Cholecystectomy During Admission No Cholecystectomy Cholecystectomy Performed 0.40 0.24 0.65 < 0.01