Outcomes of inpatient cholecystectomy among adults with cystic fibrosis in the United States

Table 1 Comparison of characteristics between subjects with and without cystic fibrosis who underwent cholecystectomy from 2002 to 2014

	Without cystic fibrosis (n = 5974985)		With cystic fibrosis (n = 1239)
	n	%	n	%	P value
Patient and hospital characteristics
Age (mean ± SE)	53.81	0.05	31.28	0.80	< 0.001
Gender					0.342
Male	2113648	35.45	475	38.35
Female	3848224	64.55	764	61.65
Race					< 0.001
White	3377462	68.16	917	90.92
Black	486644	9.82	15	1.51
Hispanic	784975	15.84	38	3.81
Other	306042	6.18	38	3.75
Income quartile					0.669
First	1443591	26.81	270	23.36
Second	1423075	26.43	322	27.83
Third	1342530	24.94	313	27.06
Fourth	1174730	21.82	251	21.76
Primary payer					< 0.001
Medicare	2013023	33.76	255	20.62
Medicaid	689680	11.57	215	17.34
Private insurance	2550634	42.77	646	52.16
Other	710118	11.91	122	9.88
Elixhauser co-morbidity score					0.095
< 3	4425355	74.06	974	78.62
≥ 3	1549630	25.94	265	21.38
Chronic respiratory failure	16136	0.27	24	1.96	< 0.001
Hospital bed size					0.044
Small	744565	12.50	89	7.27
Medium	1569622	26.36	306	24.87
Large	3639976	61.13	835	67.86
Hospital location/teaching status					< 0.001
Rural	786013	13.20	57	4.67
Urban non-teaching	2724014	45.75	252	20.52
Urban teaching	2444135	41.05	920	74.82
Hospital region					0.184
Northeast	1048152	17.54	210	16.93
Midwest	1248121	20.89	335	27.00
South	2369451	39.66	467	37.65
West	1309262	21.91	228	18.42
Cholecystectomy approach					0.003
Laparoscopic	4192051	70.16	973	78.55
Open	1782934	29.84	266	21.45
Indication for cholecystectomy1					< 0.001
Acute cholecystitis	3606140	60.35	597	48.14
Chronic cholecystitis	317489	5.31	98	7.90
Gallstone disease without cholecystitis	1077090	18.03	329	26.58
Biliary dyskinesia	71204	1.19	62	5.03
Other	903063	15.11	153	12.35

¹Hierarchy model.

Table 2 Univariate analysis of outcomes between propensity weighted cohort of patients with and without cystic fibrosis who underwent laparoscopic cholecystectomy in the Nationwide Inpatient Sample 2002-2014

	Without cystic fibrosis (n = 722)		With cystic fibrosis (n = 731)
	n	%	n	%	P value
Mortality1	≤ 10	≤ 1.39	≤ 10	≤ 1.37	0.662
Length of stay (mean ± SE)	5.18	0.33	9.36	0.89	< 0.001
Cost ($) (mean ± SE)	14103	842	25891	3859	0.003
Pulmonary complications	29	4.05	49	6.64	0.109
Surgical complications	16	2.27	33	4.48	0.094

¹Where n ≤ 10, the exact value is censored to protect patient privacy, per Nationwide Inpatient Sample regulation.

Table 3 Comparison of characteristics between subjects with cystic fibrosis who underwent open compared to laparoscopic cholecystectomy from 2002 to 2014

	Laparoscopic CCY (n = 973)		Open CCY (n = 266)
	n	%	n	%	P value
Patient and hospital characteristics
Age (mean ± SE)	30.78	0.86	33.11	1.95	0.272
Gender					0.005
Male	330	33.92	145	54.60
Female	643	66.08	121	45.40
Race					0.911
White	718	90.92	199	90.93
Black	≤ 10	≤ 1.03	≤ 10	≤ 3.76
Hispanic	29	3.65	≤ 10	≤ 3.76
Other	33	4.13	≤ 10	≤ 3.76
Income quartile					0.110
First	210	23.22	60	23.86
Second	221	24.47	100	39.95
Third	264	29.20	48	19.34
Fourth	209	23.11	42	16.85
Primary payer					0.265
Medicare	221	22.73	34	12.86
Medicaid	177	18.23	37	14.07
Private insurance	482	49.56	164	61.69
Other	92	9.47	30	11.38
Elixhauser co-morbidity score					0.311
< 3	778	79.93	196	73.81
≥ 3	195	20.07	70	26.19
Chronic respiratory failure	24	2.50	0	0.00	-
Hospital bed size					0.244
Small	71	7.29	19	7.21
Medium	219	22.58	87	33.34
Large	679	70.13	155	59.45
Hospital location/teaching status					0.476
Rural	53	5.45	≤ 10	≤ 3.76
Urban non-teaching	193	19.94	59	22.67
Urban teaching	723	74.61	197	75.56
Hospital region					0.812
Northeast	167	17.15	43	16.12
Midwest	258	26.53	76	28.73
South	378	38.85	88	33.27
West	170	17.47	58	21.88
Indication for cholecystectomy1
Acute cholecystitis	527	54.17	69	26.07
Chronic cholecystitis	84	8.61	14	5.28
Gallstone disease without cholecystitis	285	29.25	45	16.82
Biliary dyskinesia2	58	5.95	≤ 10	≤ 3.76
Other	20	2.02	133	50.18

¹Hierarchy model.

²Where n ≤ 10, the exact value is censored to protect patient privacy, per Nationwide Inpatient Sample regulation. CCY: Cholecystectomy.

Table 4 Multivariate comparison of post-operative outcomes between subjects with cystic fibrosis who underwent open compared to laparoscopic cholecystectomy from 2002 to 2014

	Length of stay			Hospitalization cost
	Days	95%CI	P value	$	95%CI	P value
Open cholecystectomy	4.82	(0.82, 8.83)	0.018	18449	(5582, 31316)	0.005
Elixhauser co-morbidity score ≥ 3	8.35	(4.28, 12.43)	< 0.001	28344	(10548, 46141)	0.002
Hospital location/teaching status			< 0.001			< 0.001
Rural	-5.88	(-11.53, -0.24)		-13801	(-22490, -5111)
Urban non-teaching	-3.69	(-5.71, -1.68)		-13709	(-20684, -6734)
Urban teaching	Ref.			Ref.

Adjusted for significant covariates.