Regional differences in hospitalizations and cholecystectomies for biliary dyskinesia

Abstract

Background/aims: Published studies suggest that socioeconomic factors contribute to increasing cholecystectomy rates for biliary dyskinesia (BD). The aim of this study was to identify factors driving admissions and operations for BD by examining regional variability in hospitalizations and cholecystectomies for this disorder.

Methods: Annual hospitalizations and cholecystectomy rates for biliary diseases were assessed using the State Inpatient Databases of the Agency for Healthcare Research and Quality based on diagnosis codes for biliary dyskinesia, cholecystolithiasis and cholecystitis.

Results: Annual admissions for BD varied nearly sevenfold among different states within the United States. Hospitalizations for gallstone disease and its complication showed less variability, differing 2-fold between states. Nearly 70% of admissions for BD and about 85% of admissions for gallstone disease resulted in cholecystectomies. Higher admission rates for BD were best predicted by high overall hospitalization rates, admission rate for gallstone disease and the physician workforce within a state. Cholecystectomy rates for BD were higher in states with low population density and high rates of cholecystectomy for gallstone disease.

Conclusions: These data suggest that established medical practice patterns significantly contribute to the variability in admissions and operations for biliary dyskinesia. The findings also indicate that lower thresholds for operative interventions are an important determinant in the approach to this disorder. Considering the benign course of functional illnesses, the bar for surgical interventions should be raised rather than lowered; in addition active conservative treatment options should be developed for these patients.

Keywords: Cholecystectomy; Delivery of health care; Gastrointestinal disease.

Figure 1

Regional variation in annual admission rates for biliary dyskinesia within the United States. White, no data; light grey, 1-2/100,000; dark grey, 2-4/100,000; black, > 4/100,000.

Figure 2

Scatterplots depicting the relationship between the fraction of pediatric admission for biliary dyskinesia (A) or complications of gallstone disease (B) the overall admission rates for these disorders normalized by population size.

Figure 3

Scatter plots showing the correlation between admissions for biliary dyskinesia (A) and gallstone disease (B) and overall annual hospitalizations, normalized by population size. The relationship for admissions and cholecystectomy rates between these biliary diseases is depicted in C and D.