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Trends and risk factors for 30-day readmissions in patients with acute cholangitis: analysis from the national readmission database

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A Correction to this article was published on 25 January 2022

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Abstract

Introduction

Acute cholangitis (AC) can be associated with significant mortality and high risk of readmissions, if not managed promptly. We used national readmission database (NRD) to identify trends and risk factors associated with 30-day readmissions in patients with AC.

Methods

We conducted a retrospective cohort study of adult patients admitted with AC from 2010–2014 and Q1-Q3 of 2015 by extracting data from NRD. Initial admission with a primary diagnosis of acute cholangitis (ICD-9 code: 576.1) was considered as the index admission and any admission after index admission was considered a readmission regardless of the primary diagnosis. Multivariable regression analyses were performed to assess the association.

Results

From 52,906 AC index admissions, overall 30-day readmission rate was 21.48% without significant differences in the readmission rates across the study period. There was significant increase in the overall hospital charges for readmissions, while a significant reduction in the death rate was observed during the first readmission. Recurrent cholangitis (14%), septicemia (6.4%), and mechanical complication of bile duct prosthesis (3%) were the most common reasons for readmissions. The risk of readmission was significantly higher in patients with pancreatic neoplasm (OR 1.6, 95% CI 1.4–1.8), those who underwent percutaneous biliary procedures (OR 1.4, 95% CI 1.2–1.6), and who had an acute respiratory failure (OR 1.2, 95% CI 1.0–1.15). Other factors contributing to increased risk of readmissions included patients with Charleston comorbidity index > 3, diabetes, and length of stay > 3 days. Readmission risk was significantly lower in patients who underwent ERCP (OR 0.80, 95% CI 0.73–0.88) or cholecystectomy (OR 0.54, 95% CI 0.43–0.69).

Conclusions

AC is associated with a high 30-day readmission rate of over 21%. Patients with malignant biliary obstruction, increased comorbidities, and those who undergo percutaneous drainage rather than ERCP seem to be at the highest risk.

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Funding

Shashank Sarvepalli is supported by a National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Institutional National Service Award (T32) from the National Institutes of Health under Award Number T32 DK083266.

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Authors and Affiliations

  1. Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, USA

    Malav P. Parikh, Rajat Garg, Vibhu Chittajallu, Niyati Gupta & Shashank Sarvepalli

  2. Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA

    Prashanthi N. Thota, Hassan Siddiki, Amit Bhatt, Prabhleen Chahal, Sunguk Jang, Tyler Stevens, John Vargo, Arthur McCullough & Madhusudhan R. Sanaka

  3. Department of Biostatistics and Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, USA

    Rocio Lopez

  4. Department of Gastroenterolgy, Cleveland Clinic Foundation, Desk Q39500 Euclid Avenue, Cleveland, OH, 44195, USA

    Madhusudhan R. Sanaka

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  1. Malav P. Parikh
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  2. Rajat Garg
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Corresponding author

Correspondence to Madhusudhan R. Sanaka.

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Disclosures

Dr. Parikh, Dr. Garg, Dr. Chiitajallu, Dr. Gupta, Dr. Sarvepalli, Ms. Lopez, Dr. Thota, Dr. Siddiki, Dr. Bhatt, Dr. Chahal, Dr. Jang, Dr. Stevens, Dr. Vargo, Dr. McCullough, and Dr. Sanaka have no conflicts of interest and nothing to disclose.

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Parikh, M.P., Garg, R., Chittajallu, V. et al. Trends and risk factors for 30-day readmissions in patients with acute cholangitis: analysis from the national readmission database. Surg Endosc 35, 223–231 (2021). https://doi.org/10.1007/s00464-020-07384-z

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