Association for Academic Surgery Predicting complicated choledocholithiasis 5 Kristy L. Kummerow, MD, a Julia Shelton, MD, MPH, a Sharon Phillips, MSPH, b Michael D. Holzman, MD, MPH, a William Nealon, MD, a William Beck, MD, a Kenneth Sharp, MD, a and Benjamin K. Poulose, MD, MPH a, * a Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee b Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee article info Article history: Received 14 January 2012 Received in revised form 23 March 2012 Accepted 17 April 2012 Available online 7 May 2012 Keywords: Choledocholithiasis Cholangitis Acute pancreatitis Risk stratification Transfer Access to care Health disparities Race abstract Introduction: Management of choledocholithiasis and its complications is variable and often requires transfer to a specialty facility. This study links patient-specific characteristics with the outcome measure of complicated choledocholithiasis to identify high-risk patients who may require expedited treatment or transfer to a higher level of care. Materials and methods: Patients with a discharge diagnosis of choledocholithiasis (CDL) were identified from the 2009 Nationwide Inpatient Sample (NIS). Patient characteristics were identified associated with the primary outcome measure of complicated chol- edocholithiasis (cCDL), defined as acute pancreatitis or cholangitis during the admission for CDL. Predictors of mortality were also evaluated. Analysis was performed using complex-sample univariate and adjusted analyses. Results: We identified 123,990 discharges with a diagnosis of CDL. The overall incidence of CDL was 314 per 100,000 NIS discharges. Forty-one percent of CDL discharges were for cCDL (acute pancreatitis 31%, cholangitis 12%). Risk factors for cCDL included age (risk increased 0.8% per year), male gender (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.1e1.2), alcohol abuse (OR 1.5, CI 1.3e1.8), diabetes (OR 1.1, CI 1.0e1.2), hypertension (OR 1.1, CI 1.0 e1.2), obesity (OR 1.2, CI 1.1e1.3), nonelective admission (OR 2.3, CI 2.0e2.6), and Asian/ Pacific Islander race/ethnicity (OR 1.2, CI 1.0e1.5). Patients with cCDL had increased odds of mortality (OR 1.5, CI 1.2e2.0). Conclusions: Increased age, nonelective admission, and specific comorbid conditions are associated with cCDL, which has increased mortality. These factors can be used to identify patients needing timely access to treatment or transfer to a higher level of care. ª 2012 Elsevier Inc. All rights reserved. 1. Introduction Gallstone disease remains a widespread problem affecting about 10% of the United States population [1]. Of particular concern are complications of choledocholithiasis (CDL), including pancreatitis and cholangitis, which carry mortality rates of 1%e3% and 10%, respectively [2e4]. Management of common duct stones varies widely, ranging from endoscopic retrograde cholangiopancreatography to surgical or percuta- neous intervention, and often requires transfer of care to 5 Abstract to be presented at oral session during the 2012 meeting of the Academic Surgical Congress on Feb. 16th, 2012. * Corresponding author. D-5203 Medical Center North, VUMC, 1161 21st Avenue South, Nashville, TN 37232. Tel.: þ1 615 343 5613; fax: þ1 615 343 9485. E-mail address: benjamin.poulose@vanderbilt.edu (B.K. Poulose). Available online at www.sciencedirect.com journal homepage: www.JournalofSurgicalResearch.com journal of surgical research 177 (2012) 70 e74 0022-4804/$ e see front matter ª 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.jss.2012.04.034