H. A. Thacker1, M. S. Stega1, S. Patil1, Y. Zhang1, M. Jacobs1 1Ascension Providence Hospital, Department Of Hepatopancreaticobiliary Surgery, Southfield, MI, USA
Introduction: Cholecystoenteric fistula (CEF) is a rare and dangerous complication of acute cholecystitis, with a reported incidence of 3%-5%. Management and outcomes of CEF are poorly studied outside case reports and single institution case series. The current study is the first population based study analyzing treatment and outcomes of CEF
Methods: Nationwide Inpatient Sample Database (NIS 1998-2015) was used to identify patients with cholecystoenteric fistula (ICD 9 575.5). Demographics and clinical data including, gender, race, Charlson’s score, surgical intervention, hospital type, discharge disposition, length of stay (LOS), and in-hospital mortality was abstracted and compared between male and female patients using standard statistical methods. Discharge weights were applied to obtain national estimates.
Results: A total of 14,878 CEF patients were identified for the study period. Mean age was 69.3±14.2 years. Caucasians contributed to highest number of patients (62.4%), followed by Hispanics (9.2%), and African Americans (6.1%). Majority of patients had a Charlson’s score of four or higher (47.4%). 54.7% of patients received total cholecystectomy, 11.3% received partial cholecystectomy, 4.9% received choledochoplasty, and 2.6% received biliary enteric anastomosis. Mean LOS was 10.8±10.3 days, Majority of CEF patients presented to urban teaching hospitals (50.1%), followed by urban non-teaching hospital (37.6%) and rural hospitals (12.3%). 51.9% of patients were discharged to home, 22.4% to skilled nursing facility, and 17.1% required home health. In-hospital mortality was 5.1%
Conclusion: In the current study the average age of presentation with CEF was 7th decade. Majority of patients had a higher Charlon’s score of 4 or more. Total cholecystectomy was the most common surgical intervention with acceptable in-hospital mortality. Future research looking into risk factors and factors influencing mortality will help clinicians to stratify risk and establish treatment strategies in these complex patients.
