Award: Presidential Poster Award
Andrew Thompson1, Violeta Popov, MD, PhD2
1New York University School of Medicine, New York, NY; 2New York University, New York, NY
Introduction: Rapid weight loss after bariatric surgery (BS) is associated with the development of gallstones. It may increase the risk of biliary disease including acute pancreatitis (AP), acute cholecystitis(AC), acute cholangitis (Chol), and may lead to a cholecystectomy(CCY). To avoid these complications, CCY was typically performed during open bariatric procedures. However, with the advent of laparoscopic BS, concomitant CCY with BS has decreased for many reasons, thus potentially leading to increased gallstone-related complications. The aim of this study was to assess if AP, AC, Chol, CCY have increased with this change in practice.
Methods: This was a retrospective analysis using the National Inpatient Sample (NIS), the largest publically available inpatient database in the United States. All patients with an ICD-9 CM code for a diagnosis of prior BS, AP, AC, Chol, and procedure code for CCY were included. The primary outcome was the proportion of patients with prior BS who were admitted for AP, AC, Chol, and CCY in 2006 compared to 2014 (2006 being the first year when the code of prior BS was used). The secondary outcomes were mortality, cost, and length of stay. Logistic regression was used to calculate p values among years.
Results: A total of 135,980 patient were admitted with AC in 2006 and 2014 combined; 98,098 patients were admitted with Chol; 782,395 were admitted with AP, and 861,549 underwent CCY. Notably, patients with history of bariatric surgery were 10 to 100-fold more likely to be admitted for any of the gallstone-related biliary disease in 2014 compared to 2006 (Table 1). The mean patient age ranged from 52.3 to 63.7 years; however, the subset of patients with prior bariatric surgery who were admitted with gallstone complications was significantly younger: range 42.8 for AC in 2006 to 54.7 with Chol in 2014. Length of stay was also shorter for patients with prior bariatric surgery, and their charges were lower, reflecting this trend (Table 1). History of bariatric surgery was associated with lower inpatient mortality among these patients, younger age, length of stay and lower overall cost.
Discussion: Change in surgical practice over the past decade has had a major impact on subsequent biliary disease in patients with bariatric surgery, with an increase in admissions for acute cholecystitis, acute cholangitis, acute pancreatitis and cholecystectomy.
Disclosures: Does Disclose
Citation: Andrew Thompson; Violeta Popov, MD, PhD. BILIARY DISEASE HAS INCREASED IN PATIENTS WITH BARIATRIC SURGERY OVER THE PAST DECADE: A NATIONWIDE ANALYSIS. Program No. P1610. ACG 2018 Annual Scientific Meeting Abstracts. Philadelphia, Pennsylvania: American College of Gastroenterology.