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 20 April 2018

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News

Guideline-recommended cholecystectomy to prevent recurrent pancreatitis

The latest American Journal of Gastroenterology examines the effectiveness of guideline-recommended cholecystectomy to prevent recurrent pancreatitis.

News image

Cholecystectomy during or within 4 weeks of hospitalization for acute biliary pancreatitis is recommended by guidelines. 

Dr Susan Hutfless and colleagues from Maryland, USA examined adherence to the guidelines for incident mild-to-moderate acute biliary pancreatitis, and the effectiveness of cholecystectomy to prevent recurrent episodes of pancreatitis.

Individuals in the 2010–2013 MarketScan Commercial Claims & Encounters database with a hospitalization associated with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes of 577.0 for acute pancreatitis and 574.x for gallstone disease were eligible. 

The team considered guideline adherence as cholecystectomy within 30 days of the first/index hospitalization for biliary pancreatitis. 

1,213 had a cholecystectomy 1–6 months after the index hospitalization
American Journal of Gastroenterology
Individuals with and without guideline-adherent cholecystectomy were compared for subsequent hospitalization for acute or chronic pancreatitis using a Cox proportional hazards model adjusted for age, sex, comorbidities, and length of index hospital stay.

The researchers found that of the 17,010 patients who met the inclusion criteria, 78% were adherent with the guidelines, including 10,918 who underwent cholecystectomy during the index hospitalization and 2,387 who underwent cholecystectomy within 30 days. 

Among 3,705 patients non-adherent with the guidelines, the team noted that 1,213 had a cholecystectomy 1–6 months after the index hospitalization. 

Guideline-adherent cholecystectomy resulted in fewer subsequent hospitalizations for acute and chronic pancreatitis as compared with non-adherence to the guidelines.

Dr Hutfless' team concludes, "Nearly 4 out of 5 patients underwent cholecystectomy for acute biliary pancreatitis in a timeframe, consistent with guidelines."

"Adherence resulted in a decrease in subsequent hospitalizations for both acute and chronic pancreatitis."

"However, the majority of non-adherent patients did not undergo a subsequent cholecystectomy."

"There may be factors that predict the need for immediate vs. delayed cholecystectomy."

Am J Gastroenterol 2017; 112:503–510
14 March 2017

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