Effect of medical or surgical admission on outcome of patients with gallstone pancreatitis and common bile duct stones.
BACKGROUND
Management of uncomplicated common bile duct stone (CBDS) and gallstone pancreatitis (GP) presumably varies based on whether a patient is admitted to medicine or surgery. This study evaluates the impact of admitting team on outcome and cost.


METHODS
Three hundred seventy patients admitted to the Massachusetts General Hospital for CBDS or GP were retrospectively analyzed for demographics, insurance status, procedures, complications, length of stay, readmission, and cost. A multivariable analysis was conducted for outcome and cost measures.


RESULTS
Patients admitted to a surgical service were younger than those admitted to a medical service. Gender, race, tobacco use, and the presence of chronic obstructive pulmonary disease and chronic renal insufficiency were not significantly different between groups. Patients admitted to a medical service had a higher incidence of coronary artery disease and diabetes. Despite lower readmission rates for surgical patients, there was no difference in total hospital days between groups. Though total cost of an initial surgical admission was greater than a medical admission, total cost attributable to the index admission diminished over time and ultimately was not significant in follow-up.


CONCLUSIONS
Despite variations in uncomplicated management of CBDS and GP, there is no difference, in long-term follow-up, in the total number of hospital days or cost for the management of CBDS or GP based on admitting team practices.
LaFemina
Jennifer
J
Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Sokal
Suzanne M
SM
Chang
Yuchiao
Y
McGrath
Deborah
D
Berger
David L
DL
D002758:Cholangiography / Q000191:economics / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000191:economics / Q000379:methods; D002763:Cholecystectomy / Q000191:economics / Q000379:methods; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000150:complications / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D017721:Hospital Costs; D006757:Hospital Units / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D010343:Patient Admission / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000191:economics; D011183:Postoperative Complications / Q000453:epidemiology; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome