Less recurrent pancreatitis seen with adherence to cholecystectomy guidelines

Last Updated: 2017-02-23

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Treating biliary pancreatitis according to cholecystectomy guidelines is associated with a smaller risk of recurrence and later hospitalization, according to new findings.

Guidelines state that patients with acute biliary pancreatitis should undergo cholecystectomy during or within four weeks of hospitalization, researchers note in the American Journal of Gastroenterology, online January 10.

"Most patients received cholecystectomy consistent with the guidelines," senior author Dr. Susan M. Huftless of Johns Hopkins University in Baltimore, Maryland, told Reuters Health by email.

"We recommend adherence to guidelines to reduce the risk of gallstone pancreatitis,” added lead author Dr. Ayesha Kamal, also of Johns Hopkins University. “Our findings suggest that adherence to guideline-recommended cholecystectomy reduces the risk of further hospitalization for gallstone pancreatitis and thus can lower medical care cost."

For the study, the two researchers and their colleagues analyzed records from the 2010-2013 MarketScan Commercial Claims and Encounters database. They considered guideline adherence to be cholecystectomy within 30 days of the first hospitalization for biliary pancreatitis.

Seventy-eight percent of the more than 17,000 patients who met the inclusion criteria were treated according to guideline timeframes, including nearly 11,000 who had a cholecystectomy during the first related hospitalization and 2,387 who had a cholecystectomy within 30 days.

Of the 3,705 patients for whom guidelines were not followed, a third had a cholecystectomy between one and six months after the first hospitalization.

Patients treated according to guidelines had fewer future hospitalizations for acute and chronic pancreatitis (acute pancreatitis, 3% vs. 13%, p<0.001; chronic pancreatitis, 1% vs. 4%, p<0.001).

"These findings surprised me as I did not expect adherence to the guidelines to be so high," Dr. Kamal told Reuters Health by email.

Dr. Huftless noted. "The community is doing a great job of getting patients into surgery rapidly in adherence with the guidelines. This is a win for patients and shows that multiple disciplines can work together to provide patients with evidence-based care."

She said the one-year window after the first hospitalization appears to be the riskiest.

"There is a real risk of delaying cholecystectomy, but with well-formulated research, this is an area where personalized medicine could be examined," Dr. Huftless advised. "At present, the personalization of cholecystectomy timing is a hypothesis and would need to be tested in rigorous studies. Until that time, there is clear evidence that the guidelines are beneficial to patients and should be followed."

"This is the largest study on this topic in the United States, including privately insured individuals under age 65," she said.

Dr. Kamal pointed out that the database is limited by “the lack of generalizability as it includes only insured individuals under 65 years of age.”

SOURCE: http://bit.ly/2mof5Ll

Am J Gastroenterol 2017.