Trends and risk factors for 30-day readmissions in patients with acute cholangitis: analysis from the national readmission database.
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
18
09
2019
accepted:
08
01
2020
pubmed:
18
1
2020
medline:
29
6
2021
entrez:
18
1
2020
Statut:
ppublish
Résumé
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. 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. 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). 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.
Identifiants
pubmed: 31950275
doi: 10.1007/s00464-020-07384-z
pii: 10.1007/s00464-020-07384-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
223-231Commentaires et corrections
Type : ErratumIn
Références
Salek J, Livote E, Sideridis K, Bank S (2009) Analysis of risk factors predictive of early mortality and urgent ERCP in acute cholangitis. J Clin Gastroenterol 43:171–175
doi: 10.1097/MCG.0b013e318157c62c
Khashab MA, Tariq A, Tariq U et al (2012) Delayed and unsuccessful endoscopic retrograde cholangiopancreatography are associated with worse outcomes in patients with acute cholangitis. Clin Gastroenterol Hepatol 10:1157–1161
doi: 10.1016/j.cgh.2012.03.029
Navaneethan U, Gutierrez NG, Jegadeesan R et al (2013) Delay in performing ERCP and adverse events increase the 30-day readmission risk in patients with acute cholangitis. Gastrointest Endosc 78:81–90
doi: 10.1016/j.gie.2013.02.003
Miura F, Okamoto K, Takada T et al (2018) Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci 25:31–40
doi: 10.1002/jhbp.509
US Department of Health & Human Services; Centers for Medicare & Medicaid Services (2008) Medicare fact sheet: quality measures for reporting in fiscal year 2009 for 2010 update. US Department of Health & Human Services, Baltimore
Epstein AM (2006) Paying for performance in the United States and abroad. N Engl J Med 355:406–408
doi: 10.1056/NEJMe068131
U.S. Bureau of Economic Analysis (2018) National income and product account tables, Table 1.1.4 price indexes for gross domestic product. https://www.bea.gov/iTable/iTable.cfm?reqid=19&step=2reqid=19&step=3&isuri=1&1910=x&0=-99&1921=survey&1903=4&1904=2010&1905=2015&1906=a&1911=0 . Accessed 7 June 2018.
Quan H, Sundararajan V, Halfon P et al (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43:1130–1139
doi: 10.1097/01.mlr.0000182534.19832.83
Tan M, Schaffalitzky de Muckadell OB, Laursen SB (2019) Unchanged mortality in patients with acute cholangitis despite an increase in malignant etiologies—a 25-year epidemiological study. Scand J Gastroenterol 54:335–341
doi: 10.1080/00365521.2019.1585568
Committee ATA, Pfau PR, Pleskow DK et al (2013) Pancreatic and biliary stents. Gastrointest Endosc 77:319–327
doi: 10.1016/j.gie.2012.09.026
Lee CC, Chang IJ, Lai YC, Chen SY, Chen SC (2007) Epidemiology and prognostic determinants of patients with bacteremic cholecystitis or cholangitis. Am J Gastroenterol 102:563–569
doi: 10.1111/j.1572-0241.2007.01095.x
McNabb-Baltar J, Trinh QD, Barkun AN (2013) Disparities in outcomes following admission for cholangitis. PLoS ONE 8:e59487
doi: 10.1371/journal.pone.0059487
Sawas T, Al Halabi S, Parsi MA, Vargo JJ (2015) Self-expandable metal stents versus plastic stents for malignant biliary obstruction: a meta-analysis. Gastrointest Endosc 82:256–267e7
doi: 10.1016/j.gie.2015.03.1980
Boender J, Nix GA, de Ridder MA et al (1995) Endoscopic sphincterotomy and biliary drainage in patients with cholangitis due to common bile duct stones. Am J Gastroenterol 90:233–238
pubmed: 7847292
pmcid: 7847292
Mulki R, Shah R, Qayed E (2019) Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: a nationwide analysis. World J Gastrointest Endosc 11:41–53
doi: 10.4253/wjge.v11.i1.41
Hou LA, Laine L, Motamedi N, Sahakian A, Lane C, Buxbaum J (2017) Optimal timing of endoscopic retrograde cholangiopancreatography in acute cholangitis. J Clin Gastroenterol 51:534–538
doi: 10.1097/MCG.0000000000000763
Parikh MP, Wadhwa V, Thota PN, Lopez R, Sanaka MR (2018) Outcomes associated with timing of ERCP in acute cholangitis secondary to choledocholithiasis. J Clin Gastroenterol 52:e97–e102
doi: 10.1097/MCG.0000000000000982
Parikh MP, Gupta NM, Thota PN, Lopez R, Sanaka MR (2018) Temporal trends in utilization and outcomes of endoscopic retrograde cholangiopancreatography in acute cholangitis due to choledocholithiasis from 1998 to 2012. Surg Endosc 32:1740–1748
doi: 10.1007/s00464-017-5856-7
Mukai S, Itoi T, Baron TH et al (2017) Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo Guidelines 2018. J Hepatobiliary Pancreat Sci 24:537–549
doi: 10.1002/jhbp.496
Huang RJ, Barakat MT, Girotra M, Banerjee S (2017) Practice patterns for cholecystectomy after endoscopic retrograde cholangiopancreatography for patients with choledocholithiasis. Gastroenterology 153(762–71):e2
Barba R, Marco J, Ruiz J et al (2015) The obesity paradox in stroke: impact on mortality and short-term readmission. J Stroke Cerebrovasc Dis 24:766–770
doi: 10.1016/j.jstrokecerebrovasdis.2014.11.002
Hanly RJ, Marvi SK, Whitehouse SL, Crawford RW (2017) Morbid Obesity in total knee arthroplasty: joint-specific variance in outcomes for operative time, length of stay, and readmission. J Arthroplasty 32:2712–2716
doi: 10.1016/j.arth.2017.03.060
Enomoto LM, Shrestha DP, Rosenthal MB, Hollenbeak CS, Gabbay RA (2017) Risk factors associated with 30-day readmission and length of stay in patients with type 2 diabetes. J Diabetes Complicat 31:122–127
doi: 10.1016/j.jdiacomp.2016.10.021
Minana G, Bosch MJ, Nunez E et al (2017) Length of stay and risk of very early readmission in acute heart failure. Eur J Intern Med 42:61–66
doi: 10.1016/j.ejim.2017.04.003
Rinne ST, Graves MC, Bastian LA et al (2017) Association between length of stay and readmission for COPD. Am J Manag Care 23:e253–e258
pubmed: 29087152
pmcid: 29087152
Sukanya C (2017) Validity of principal diagnoses in discharge summaries and ICD-10 coding assessments based on National Health Data of Thailand. Healthc Inform Res 23:293–303
doi: 10.4258/hir.2017.23.4.293