P0010 - Acute Acalculous Cholecystitis: Recent Findings, Disparities, and Analysis of a National Database

Faris Shweikeh, MD¹, Caroline Mangira, MPH¹, Mohamad Mouchli, MD^2
1Cleveland Clinic Akron General, Akron, OH; ²Cleveland Clinic, Cleveland, OH

Introduction: Acute acalculous cholecystitis (AAC) is as an acute inflammatory condition of the gallbladder without gallstones. Its pathophysiology is not totally understood and it can have substantial morbidity and mortality. Treatment options include conservative approaches, cholecystectomy, and cholecystostomy drainage, though controversies remain with this regard. The goal of this study is to report recent national findings on AAC and to address possible disparities in care.

Methods: The 2019 National Inpatient Sample, a nationwide database, was utilized to identify and quantify all adult AAC hospitalizations in the United States. The differences among patients’ characteristics between those getting cholecystectomy vs. drainage and those receiving an intervention vs. no intervention were assessed using statistical methods.

Results: There were 548 patients included. Females outnumbered males (57.1% vs. 42.9%), 35.4% were 45 to 64 years (largest age group), 66.0% were White, 41.4% were on Medicare, and 46% had an intervention (cholecystectomy or drainage). The South (45.6%) was the most common geographically. Multiple logistic regression showed that females were 51% more likely (vs. males, p=0.041), Hispanics were 67% less likely (vs. Whites, p=0.0028) and those on Medicaid were 66% less likely (vs. private insurance, p=0.0015) to have an intervention (Table 1). Those receiving an intervention were more likely to have a routine discharge (i.e., to home) vs. no intervention, (83.4% vs. 61.9%, p < 0.0001), but had higher total charges ($47,728 vs. $23,411, p< 0.0001). Univariate odds ratio estimates showed females were 3.3 times more likely than males to receive a cholecystectomy vs. cholecystostomy drainage (p=0.0068). Additionally, those who received a cholecystectomy were younger (mean age 52.8 vs 61.9 years, p=0.022) and were 13.29 times more likely to have a routine discharge (vs. cholecystostomy, p< 0.0001).

Discussion: Results of this study indicate that gender, race, age, and insurance status impact treatment decisions in AAC patients. Patients in Southern states have a higher predilection for this condition. Cholecystectomy was associated with a better outcome than drainage without significantly higher costs. However, a high number of patients in this study received no intervention for AAC and likely received conservative management strategies only. Future studies should look further into our findings and the disparities that were discovered.



Disclosures:


Faris Shweikeh, MD¹, Caroline Mangira, MPH¹, Mohamad Mouchli, MD². P0010 - Acute Acalculous Cholecystitis: Recent Findings, Disparities, and Analysis of a National Database, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.