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Racial disparities in cholecystectomy rates during hospitalizations for acute gallstone pancreatitis: a national survey.
Nguyen, Geoffrey C; Tuskey, Anne; Jagannath, Sanjay B.
Afiliação
  • Nguyen GC; Mount Sinai Hospital, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.
Am J Gastroenterol ; 103(9): 2301-7, 2008 Sep.
Article em En | MEDLINE | ID: mdl-18844616
ABSTRACT

BACKGROUND:

Practice guidelines advocate performing cholecystectomy for acute gallstone pancreatitis during the same hospitalization stay. Our objectives were to determine nationwide rates of adherence to these guidelines in the United States and whether this varied with race and ethnicity.

METHODS:

We queried the Nationwide Inpatient Sample (NIS) to identify admissions for acute gallstone pancreatitis between 1998 and 2003. We calculated overall and race-specific proportions of patients who underwent cholecystectomy or endoscopic retrograde cholangiopancreatography (ERCP) prior to discharge. We used multivariate analysis to determine racial effects while adjusting for age, comorbidity, health insurance payer, and hospital factors.

RESULTS:

The overall rate of cholecystectomy was 51% and that of either cholecystectomy or ERCP was 62%. Cholecystectomy rates were lower among African Americans (AAs) and Asians compared to Whites (44% and 43%, respectively, vs 50%, P < 0.001). After multivariate adjustment, the odds of cholecystectomy was lower in AAs (OR 0.68, 95% CI 0.63-0.73) and Asians/Pacific Islanders (OR 0.75, 95% CI 0.65-0.87) relative to Whites, while rates were modestly higher among Hispanics (OR 1.12, 95% CI 1.03-1.22). AAs were less likely to receive ERCP than Whites (OR 0.71, 95% CI 0.65-0.78). In contrast, Asians/Pacific Islanders (OR 1.40, 95% CI 1.16-1.69) and Hispanics (OR 1.19, 95% CI 1.09-1.29) were more likely to receive ERCP than Whites.

CONCLUSIONS:

Despite practice guidelines, about only half of admissions for gallstone pancreatitis receive cholecystectomy during the same hospitalization, and cholecystectomy rates vary substantially by race. These findings raise concerns regarding suboptimal healthcare delivery.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Pancreatite / Colecistectomia / Cálculos Biliares / Disparidades em Assistência à Saúde Tipo de estudo: Guideline / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged País como assunto: America do norte Idioma: En Ano de publicação: 2008 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Pancreatite / Colecistectomia / Cálculos Biliares / Disparidades em Assistência à Saúde Tipo de estudo: Guideline / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged País como assunto: America do norte Idioma: En Ano de publicação: 2008 Tipo de documento: Article