title: Effectiveness of Guideline-Recommended Cholecystectomy to Prevent Recurrent Pancreatitis.
abstract: Cholecystectomy during or within 4 weeks of hospitalization for acute biliary pancreatitis is recommended by guidelines. We examined adherence to the guidelines for incident mild-to-moderate acute biliary pancreatitis and the effectiveness of cholecystectomy to prevent recurrent episodes of pancreatitis.
  
  
  
  Individuals in the 2010-2013 MarketScan Commercial Claims & Encounters database with a hospitalization associated with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes of 577.0 for acute pancreatitis and 574.x for gallstone disease were eligible. Guideline adherence was considered cholecystectomy within 30 days of the first/index hospitalization for biliary pancreatitis. Individuals with and without guideline-adherent cholecystectomy were compared for subsequent hospitalization for acute or chronic pancreatitis using a Cox proportional hazards model adjusted for age, sex, comorbidities, and length of index hospital stay.
  
  
  
  Of the 17,010 patients who met the inclusion criteria, 78% were adherent with the guidelines, including 10,918 who underwent cholecystectomy during the index hospitalization and 2,387 who underwent cholecystectomy within 30 days. Among 3,705 patients non-adherent with the guidelines, 1,213 had a cholecystectomy 1-6 months after the index hospitalization. Guideline-adherent cholecystectomy resulted in fewer subsequent hospitalizations for acute and chronic pancreatitis as compared with non-adherence to the guidelines (acute pancreatitis: 3% vs. 13%, P<0.001; chronic pancreatitis: 1% vs. 4%, P<0.001).
  
  
  
  Nearly four out of five patients underwent cholecystectomy for acute biliary pancreatitis in a timeframe, consistent with guidelines. Adherence resulted in a decrease in subsequent hospitalizations for both acute and chronic pancreatitis. However, the majority of non-adherent patients did not undergo a subsequent cholecystectomy. There may be factors that predict the need for immediate vs. delayed cholecystectomy.
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Kamal
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Eboselume
authors.initials: E
authors.lastname: Akhuemonkhan
authors.affiliation: Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Venkata S
authors.initials: VS
authors.lastname: Akshintala
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Kalloo
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA.|Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Hutfless
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002763:Cholecystectomy / Q000379:methods*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D042882:Gallstones / Q000150:complications / Q000601:surgery*; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D050500:Pancreatitis, Chronic / Q000209:etiology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods*; D012720:Severity of Illness Index; D055815:Young Adult