Hospital volume as a predictor for undergoing cholecystectomy after admission for acute biliary pancreatitis.

OBJECTIVE

We explored whether admission volumes for cholecystectomy (CCY) and pancreatitis were associated with receiving CCY after hospitalization for acute biliary pancreatitis (ABP).

METHODS

We identified admissions for ABP in the Nationwide Inpatient Sample between 1998 and 2003. We used multivariate analysis to assess the association between likelihood of CCY and hospital volumes of CCY, pancreatitis, and endoscopic retrograde cholangiopancreatography (ERCP).

RESULTS

The overall rate of CCY for ABP was 50%. After adjustment for confounders, the likelihood of CCY increased with every quartile of CCY volume relative to the bottom quartile (adjusted odds ratios of 4.36, 7.92, and 12.51 for quartiles 2, 3, and 4, respectively, P < 0.0001). Pancreatitis volume was inversely correlated with likelihood of CCY (adjusted odds ratios of 0.72, 0.62, and 0.48 for quartiles 2, 3, and 4, respectively, vs bottom quartile, P < 0.01). Admissions to hospitals in the top quartile for ERCP volume (>35 ERCPs/yr) had 15% lower odds of CCY than the lowest quartile. Patients from rural areas and with lower income were disproportionately admitted to hospitals with lower CCY volumes.

CONCLUSIONS

US hospitals are not achieving targets for CCY after ABP as set by national and international guidelines. Centers with smaller CCY volumes are the least adherent to recommendations for CCY possibly because of hospital-level resource limitations.