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.

中文翻译：

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因胆源性急性胰腺炎或胆总管结石而进行的入院胆囊切除术可降低儿童 30 天再入院率

摘要

背景

患有胆源性急性胰腺炎（BAP）或胆总管结石的成年患者在入院时未接受胆囊切除术的预后较差。鉴于缺乏关于儿童初次住院期间胆囊切除术影响的数据，我们检查了接受初次胆囊切除术的 BAP 或胆总管结石儿童患者与未接受初次胆囊切除术的儿童的再入院率。

方法

使用 2018 年国家再入院数据库 (NRD) 对患有 BAP、无感染或坏死 (ICD-10 K85.10) 或胆总管结石 (K80.3x–K80.7x) 的儿童（< 18 岁）进行回顾性研究。排除标准为坏死性胰腺炎，伴或不伴感染性坏死和入院期间死亡。进行多变量逻辑回归以确定与 30 天再入院相关的因素。

结果

2018 年，有 1122 名儿童因 BAP 指数（ n  = 377，33.6%）或胆总管结石（n  = 745，66.4%）入院。入院时平均年龄为 13 (SD 4.2) 岁；大多数患者为女性（n  = 792，70.6%）。663 例 (59.1%) 病例进行了指数胆囊切除术。在该次入院期间接受胆囊切除术的患者的 30 天再入院率为 10.9%，而未接受胆囊切除术的患者的 30 天再入院率为 48.8% ( p  < 0.001)。在多变量分析中，接受胆囊切除术的患者 30 天再入院的几率低于未接受胆囊切除术的患者（OR 0.16，95% CI 0.11-0.24，p  < 0.001）。

结论

仅 59% 因 BAP 或胆总管结石入院的儿童患者接受了指数胆囊切除术，但 30 天内再次入院的几率降低了 84%。当前的指南应更新以反映这些发现，未来的研究应评估指数胆囊切除术的障碍。