Comparative Outcomes of Acute Gallstone Disease in Patients with and without Sickle Cell Disease: A Retrospective Cohort Study Using the National Inpatient Sample

Introduction:

Sickle cell disorders are the most prevalent inherited hemoglobinopathies, affecting over 100,000 in the United States. Owing to accelerated chronic hemolysis, pigment gallstone formation is common and may be complicated by cystic or common bile obstruction. Gallstones and their acute complications also burden the general population, though favoring the cholesterol calculi subtype. In this study, we aimed to evaluate the healthcare utilization and outcomes of hospital admissions for acute biliary calculi disease in patients with sickle cell disorders compared to the general population.

Methods:

We conducted a retrospective cohort study of the 2016-2020 National Inpatient Sample dataset to compare admissions of patients age ≥ 18 years with acute gallstone disease using International Classification of Diseases-10 codes for acute cholecystitis and acute cholangitis with and without a secondary coded diagnosis of sickle cell disease (SCD). The primary outcome, length of stay, was assessed using a Poisson regression model. Secondary outcomes - total charges and admission mortality, were assessed using Poisson and logistic regression model respectively. Admission characteristics compared between patients with and without SCD included age, sex, race/ethnicity, hospital region, hospital bed size, expected primary payer, total charges, and Charlson Comorbidity score using Wald's test.

Results:

74,085 hospitalizations were identified meeting inclusion criteria of adult admissions for gallstone disease. Among these, 125 (0.17%) had SCD. Poisson regression analysis revealed SCD admissions to have 27% longer hospital stay (p < 0.002, CI [1.09 - 1.47]. Total charges were also 25% higher in SCD admissions (p = 0.014, CI [1.04 - 1.50]). There was also an observed 38% higher mortality rate in the SCD group, however this difference did not reach statistical significance (p = 0.76). Unadjusted analysis showed SCD patients with gallstone disease more likely to be younger [18-35 years] (46.40% vs 11.72%, p < 0.001), Black (84.8% vs 10.2%, p<0.001), treated in Southern state facilities (52.0% vs 39.7%, p = 0.008), have Medicaid as primary payer (32.0% vs 14.35%, p<0.001), have higher total hospital charges ($71,641.80 vs $56,421.58, p<0.001) and to have fewer comorbidities with a significant proportion having Charlson Comorbidity score of 0 (48% vs 36.42%, p=0.010).

Discussion:

Despite being younger and having fewer comorbidities, the SCD cohort had higher admission charges, longer lengths of stay, and potential trend towards higher mortality when admitted for acute gallstone disease compared to patients without SCD. This may be due to the difficulty in diagnosing acute biliary calculi in SCD patients, where symptoms often mimic a vaso-occlusive crisis, leading to delayed diagnosis. Socioeconomic disparities common in SCD patients could also contribute to these outcomes. Further research should investigate the specific mechanisms behind these findings, improve diagnostic accuracy and timeliness, and develop tailored management strategies to enhance care and prognosis for SCD patients with acute gallstone disease.

Tumin:Kate B. Reynolds Charitable Trust: Current Employment; Lilly Grant Office: Research Funding. Liles:Apellis: Research Funding; Agios: Research Funding; Bristol Myers Squibb: Research Funding; Incyte: Research Funding; Novartis: Research Funding; Pfizer: Research Funding.