Cumulative Financial Burden of Readmissions for Biliary Pancreatitis in Pregnant Women.

Abstract

To evaluate the cumulative hospitalization cost differences between routine cholecystectomy and an observational approach during index hospitalization for pregnant patients. A retrospective cohort study of 1,245 pregnant women with biliary pancreatitis across the United States between 2010 and 2014 was performed using the Nationwide Readmissions Database. Cumulative costs and complications were compared between patients with and without cholecystectomy during both initial and subsequent hospitalizations. Cholecystectomy was performed at index hospitalization in 374 patients (374/1,245 [30.0%]). Those who did not undergo index cholecystectomy experienced higher 30-day readmissions (33.7% vs 5.3%, P<.01), and 24.5% eventually underwent interval cholecystectomy. Incidence of bile duct injury was exceedingly low for cholecystectomies performed during either index or subsequent hospitalizations (4/548 [0.7%] vs 12/213 [1.5%], P<.01). No significant difference in risk of premature delivery and abortion was observed (13.3% vs 13.2%, P=.98). Most common diagnoses during readmission included cholelithiasis (44.9%), acute pancreatitis (29.9%), cholecystitis (19.9%), choledocholithiasis (12.8%), chronic pancreatitis (4.2%), cholangitis (1.7%), and pancreatic pseudocyst (1.1%). Patients who underwent cholecystectomy during the index hospitalization had the lowest average cumulative hospitalization episodes, followed by patients undergoing nonoperative management; patients undergoing interval cholecystectomy experienced the highest average hospitalization episodes (1.4 vs 1.7 vs 2.9 hospitalizations, P<.01 for both comparisons). Although initial hospitalization cost was higher for patients who underwent cholecystectomy during index admission, the cumulative hospitalization cost became lower when costs for subsequent readmissions were factored in. Early cholecystectomy should be considered in pregnant patients with biliary pancreatitis to reduce readmission costs, because there were no differences in postoperative outcomes.