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Erschienen in: Surgical Endoscopy 1/2021

01.01.2021

Trends and risk factors for 30-day readmissions in patients with acute cholangitis: analysis from the national readmission database

verfasst von: Malav P. Parikh, Rajat Garg, Vibhu Chittajallu, Niyati Gupta, Shashank Sarvepalli, Rocio Lopez, Prashanthi N. Thota, Hassan Siddiki, Amit Bhatt, Prabhleen Chahal, Sunguk Jang, Tyler Stevens, John Vargo, Arthur McCullough, Madhusudhan R. Sanaka

Erschienen in: Surgical Endoscopy | Ausgabe 1/2021

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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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Metadaten
Titel
Trends and risk factors for 30-day readmissions in patients with acute cholangitis: analysis from the national readmission database
verfasst von
Malav P. Parikh
Rajat Garg
Vibhu Chittajallu
Niyati Gupta
Shashank Sarvepalli
Rocio Lopez
Prashanthi N. Thota
Hassan Siddiki
Amit Bhatt
Prabhleen Chahal
Sunguk Jang
Tyler Stevens
John Vargo
Arthur McCullough
Madhusudhan R. Sanaka
Publikationsdatum
01.01.2021
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 1/2021
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07384-z

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