Inpatient Outcomes and 30-Day Unplanned Readmissions after Cholecystectomy in Sickle Cell Patients

Background: Recurrent episodes of hemolysis in Sickle cell Disease (SCD) patients make them more prone to developing gall stones. Its incidence varies depending on the spectrum of SCD mutations ranging from 17-58%. Cholecystectomy is one of the most common surgical procedures performed in SCD patients presenting with cholecystitis or biliary obstruction. In this study, we assess the readmission rates in SCD patients undergoing cholecystectomy and the common causes of readmission.

Methods: The Nationwide Readmissions Database (NRD) 2019 was queried to identify all adults who underwent cholecystectomy and patients with SCD were compared to those without a diagnosis of SCD. Multivariate linear and logistic regression was used to perform statistical analysis and to evaluate the risk factors for inpatient mortality, Length Of Hospital Stay (LOS), and Total Hospitalization Charges (THC). We also examined risk factors for readmissions and the most common causes of readmissions in SCD. Hospitalizations in December were excluded for readmission analysis.

Results: A total of 274,222 cholecystectomies were performed in 2019, of which 849 were for SCD patients. As expected, those with SCD were younger (mean age 35.98 vs 55.66 years, p<0.001), and there were more females in the non-SCD group (60% vs 40%, p<0.001). Sickle cell patients were likely to be treated in teaching and large-sized hospitals as reflected in table 1. After adjusting for confounders and comorbidity burden, sickle cell disease was not associated with a higher risk of inpatient mortality (aOR 3.10, 95% CI 0.74-13.05, p=0.12), however, it was associated with a longer LOS by 1.9 days (95% CI 1.37-2.47 days, p<0.001), and higher THC by roughly 13,560 USD per admission (95% CI 3,540-23,579 USD, p=0.008).

Among all patients who underwent cholecystectomy, 10.4% were readmitted. After adjusting for confounders, sickle cell disease increased the odds of readmission by 2.5 folds (aOR 2.53, 95% CI 1.76-3.66, p<0.001) and those with private insurance had a lower odds of readmission (aOR 0.69, 95% CI 0.63-0.75, p<0.001). Total LOS for readmitted patients was 401 days (193.61-609.13), mean LOS was 5.48 days (3.47-7.49), and total charges were $ 3,388,177 (1931311-4845043).

Conclusion: SCD patients undergoing cholecystectomy had a higher rate of readmission which could be attributed to stress-induced precipitation of sickle cell pain episodes. Also, they had an increased LOS and THC likely secondary to increased infections and anemia. Increased vigilance during the perioperative period in these patients may help reduce the rate of readmissions.

No relevant conflicts of interest to declare.