Multiple socioeconomic and healthcare-related disparities have been shown to affect the surgical management of acute gallstone pancreatitis, according to an analysis published in Surgical Endoscopy.

For patients with acute gallstone pancreatitis, guidelines recommend that cholecystectomy (CCY) be performed during the same admission following endoscopic retrograde cholangiopancreatography (ERCP); however, clinical practice remains variable. Researchers therefore investigated the role of clinical and sociodemographic factors in the management of acute gallstone pancreatitis in patients who underwent ERCP during hospitalization between 2008 and 2014.

Patients were classified according to treatment strategy: ERCP and same admission CCY (ERCP+CCY) vs ERCP alone. Of a total of 205,012 patients, 118,318 underwent ERCP+CCY and 86,694 underwent ERCP alone. The researchers found that a majority (53.4%) of patients who did not receive same-admission CCY were treated at urban teaching hospitals. Mean length of stay was longer (6.8±5.6 vs 6.4±6.5 days; P <.001) and with higher associated costs ($69,135±$65,913 vs $52,739±$66,681; P <.001) for patients with same-admission CCY. Mortality was significantly decreased for patients who underwent ERCP+CCY vs ERCP alone (0.4% vs 1.1%, respectively; P <.001). Multivariable regression analysis demonstrated female sex, Black race, higher Charlson Comorbidity Index, Medicare payer status, urban teaching hospital location, and lower household income decreased the odds of undergoing same-admission CCY+ERCP (all P <.001).


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The authors concluded, “Based upon our analysis, wide disparities can be seen in the management of acute gallstone pancreatitis, including multiple demographic, socioeconomic, and healthcare-related factors that influenced management.”

They added, “Given these results, future studies to investigate these socioeconomic and healthcare disparities are indicated to improve the outcomes of acute gallstone pancreatitis for all individuals, regardless of gender, race/ethnicity, socioeconomic background, or payer status.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Chouairi F, McCarty TR, Hathorn KE, et al. Evaluation of socioeconomic and healthcare disparities on same admission cholecystectomy after endoscopic retrograde cholangiopancreatography among patients with acute gallstone pancreatitis. Surg Endosc. Published online January 22, 2021. doi:10.1007/s00464-020-08272-2