Conference proceeding
Choledocholithiasis Management in Rural America: Health Disparity or Health Opportunity?
The Journal of surgical research (Print), Vol.170(2), pp.214-219
Presented at the 6th Annual Academic Surgical Congress, Huntington Beach, California, February 1-3, 2011
2011
DOI: 10.1016/j.jss.2011.03.040
PMID: 21571311
Abstract
Background
Choledocholithiasis (CDL) management is dictated by local expertise, individual training, and availability of appropriate staff. This study evaluates the management of CDL between urban and rural communities.
Materials and Methods
Patients undergoing inpatient management of CDL were identified from the 2007 Healthcare Cost and Utilization Project. Availability of endoscopic retrograde cholangiopancreatography (ERCP) was determined from the 2007 American Hospital Association survey. The proportion of common bile duct exploration (CBDE), ERCP, or percutaneous (PERC) interventions were compared across census regions and National Centers for Health Statistics (NCHS) urban–rural classes. The NCHS urban–rural classification scheme divides counties from most populous (NCHS 1) to rural (NCHS 6). Proportions were compared using the 95% confidence interval (95%CI) approach.
Results
We estimated 111,021 CDL hospitalizations in the U.S. in 2007. Of these, 67% had a coded intervention. Intervention frequencies were similar across census regions. Comparisons across NCHS classes revealed higher proportions of ERCP in urban areas (NCHS 1–4) while a higher proportion of CBDE was seen in rural areas (NCHS 5–6). ERCP availability was high in metropolitan areas (available in 35%–44% of hospitals NCHS 1–4) and low in rural areas (25% of NCHS 5 hospitals and 5% NCHS 6). PERC management was similar across NCHS classes.
Conclusions
Rural hospitals and communities need surgeons trained in CBDE, where ERCP expertise may not be readily available. Feasible ways of expanding ERCP coverage to the nation’s rural areas need to be explored. These observations may impact surgical training at least for those targeting careers in rural surgery.
Details
- Title: Subtitle
- Choledocholithiasis Management in Rural America: Health Disparity or Health Opportunity?
- Creators
- Benjamin K POULOSE - Department of Surgery, Vanderbilt University Medical Center Nashville, Tennessee, United StatesSharon PHILLIPS - Department of Biostatistics, Vanderbilt University Medical Center Nashville, Tennessee, United StatesWilliam NEALON - Department of Surgery, Vanderbilt University Medical Center Nashville, Tennessee, United StatesJulia SHELTON - Department of Surgery, Vanderbilt University Medical Center Nashville, Tennessee, United StatesKristy KUMMEROW - Department of Surgery, Vanderbilt University Medical Center Nashville, Tennessee, United StatesDavid PENSON - Department of Urologic Surgery, Vanderbilt University Medical Center Nashville, Tennessee, United StatesMichael D HOLZMAN - Department of Surgery, Vanderbilt University Medical Center Nashville, Tennessee, United States
- Resource Type
- Conference proceeding
- Publication Details
- The Journal of surgical research (Print), Vol.170(2), pp.214-219
- Conference
- Presented at the 6th Annual Academic Surgical Congress, Huntington Beach, California, February 1-3, 2011
- Publisher
- Elsevier; New York, NY
- DOI
- 10.1016/j.jss.2011.03.040
- PMID
- 21571311
- ISSN
- 0022-4804
- eISSN
- 1095-8673
- Language
- English
- Date published
- 2011
- Academic Unit
- Stead Family Department of Pediatrics; Surgery
- Record Identifier
- 9984051783102771
Metrics
15 Record Views