New England Surgical Society
NESS Home NESS Home Past & Future Meetings Past & Future Meetings

Back to 2023 Posters


Regional and hospital based socioeconomic disparities in the management of acute cholecystitis
Carmen Fahlen*, Chibueze Nwaiwu, Andrew H. Stephen, Daithi S. Heffernan
Brown University / Rhode Island Hospital, Providence, RI

Objective: Acute cholecystitis is one of the most common acute surgical presentations, and is often managed with urgent or emergent operative intervention. However, several non-medical socioeconomic factors are known to contribute to whether a patient will be offered an operation during their initial presentation. Further, it is known that socioethnic discrepancies exist between hospital types with respect to whether operative intervention can be offered across a spectrum of acute/ emergent condition. The aim of this work was to determine differences in operative versus non-operative management of acute cholecystitis across differing hospital types.
Design: A retrospective review of the National In-Patient Sample (NIS). Charts were reviewed for demographics, all diagnoses, hospital course to include whether patients underwent an operation during the initial presentation or were treated with antibiotics alone without an operative intervention.
Setting: N/A
Patients: Patients admitted with a diagnosis of acute cholecystitis from the National In-Patient Sample (NIS) across different hospital types rural (R), Urban non-teaching (UNT) and urban teaching (UT) over a 3-year period.
Interventions: N/A
Results: Overall, there were 134,130 patients, 16.8% of whom (22,516 patients) were managed with antibiotics alone and did not undergo an operation. Patients who were managed non-operatively were older (67 years (IQR=51-79) vs 55 years (IQR=38-69); p<0.001), more likely male (48.1% vs 39.3%; p<0.001) and were more likely Caucasian (64.3% versus 61.0%; p<0.05. Further, non-operatively managed patients were noted to have higher rates of comorbidities including diabetes (26% vs 18%;p<0.005), CHF (16% vs 5%;p<0.001) and dementia (6% vs 1.7%; p<0.001). Across all patients and all hospitals, there was no difference in rates of patients within the lowest income quartile between patients who were managed with versus without an operation (29.8% versus 30.1%;p>0.05). Next a multivariable model was constructed. Compared to those in the lower quartiles, patients in the top 2 income quartiles were more to be managed with an operation rather than antibiotics alone when presenting to UNT hospitals (OR1.09; 95%CI=1.03-1.14). However, within either UT or rural hospitals there was no difference in rates of operative versus non-operative management. On multivariable analysis, non-Caucasian patients were more likely to be managed non-operatively in both rural hospitals (OR=1.14; 95%CI=1.09-1.18) and UNT hospitals (OR=1.1; 95%CI=1.03-1.18), whereas no racial discrepancy was noted in UT hospitals.
Conclusions: Significant racial and social disparities exist with respect to operative versus non-operative management of acute cholecystitis. However, these disparities have different effects between hospital types. Establishing targeted region-wide guidelines would reduce these discrepancies.


Back to 2023 Posters