Journal article
Predicting complicated choledocholithiasis
The Journal of surgical research, Vol.177(1), pp.70-74
09/2012
DOI: 10.1016/j.jss.2012.04.034
PMID: 22682715
Abstract
Management of choledocholithiasis and its complications is variable and often requires transfer to a specialty facility. This study links patient-specific characteristics with the outcome measure of complicated choledocholithiasis to identify high-risk patients who may require expedited treatment or transfer to a higher level of care.
Patients with a discharge diagnosis of choledocholithiasis (CDL) were identified from the 2009 Nationwide Inpatient Sample (NIS). Patient characteristics were identified associated with the primary outcome measure of complicated choledocholithiasis (cCDL), defined as acute pancreatitis or cholangitis during the admission for CDL. Predictors of mortality were also evaluated. Analysis was performed using complex-sample univariate and adjusted analyses.
We identified 123,990 discharges with a diagnosis of CDL. The overall incidence of CDL was 314 per 100,000 NIS discharges. Forty-one percent of CDL discharges were for cCDL (acute pancreatitis 31%, cholangitis 12%). Risk factors for cCDL included age (risk increased 0.8% per year), male gender (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.1–1.2), alcohol abuse (OR 1.5, CI 1.3–1.8), diabetes (OR 1.1, CI 1.0–1.2), hypertension (OR 1.1, CI 1.0–1.2), obesity (OR 1.2, CI 1.1–1.3), nonelective admission (OR 2.3, CI 2.0–2.6), and Asian/Pacific Islander race/ethnicity (OR 1.2, CI 1.0–1.5). Patients with cCDL had increased odds of mortality (OR 1.5, CI 1.2–2.0).
Increased age, nonelective admission, and specific comorbid conditions are associated with cCDL, which has increased mortality. These factors can be used to identify patients needing timely access to treatment or transfer to a higher level of care.
Details
- Title: Subtitle
- Predicting complicated choledocholithiasis
- Creators
- Kristy L Kummerow - Department of Surgery, Vanderbilt University Medical Center, Nashville, TennesseeJulia Shelton - Department of Surgery, Vanderbilt University Medical Center, Nashville, TennesseeSharon Phillips - Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TennesseeMichael D Holzman - Department of Surgery, Vanderbilt University Medical Center, Nashville, TennesseeWilliam Nealon - Department of Surgery, Vanderbilt University Medical Center, Nashville, TennesseeWilliam Beck - Department of Surgery, Vanderbilt University Medical Center, Nashville, TennesseeKenneth Sharp - Department of Surgery, Vanderbilt University Medical Center, Nashville, TennesseeBenjamin K Poulose - Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Resource Type
- Journal article
- Publication Details
- The Journal of surgical research, Vol.177(1), pp.70-74
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jss.2012.04.034
- PMID
- 22682715
- ISSN
- 0022-4804
- eISSN
- 1095-8673
- Language
- English
- Date published
- 09/2012
- Academic Unit
- Stead Family Department of Pediatrics; Surgery
- Record Identifier
- 9984051584002771
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