Surgical management of chronic XXXX : current utilization in the United States.

@entity1 @entity154 @entity788 @entity6 @entity5 @entity1689 @entity45
BACKGROUND: Surgical intervention is uncommon in chronic @entity788 . Literature largely describes single institution or international experiences. This study describes US-based chronic @entity788 surgical management. METHODS: Retrospective analysis of chronic @entity788 @entity1 in the Healthcare Cost and Utilization Project Florida State Inpatient Database 2007-2011. @entity1 with @entity5 or @entity154 were excluded. Univariate analysis using the chi-square test. The number of readmissions, inpatient length of stay and cost using Wilcoxon's signed-rank test. Multivariate analysis of surgery by logistic regression. RESULTS: Twenty-one thousand four hundred and forty-five @entity1 with chronic @entity788 . 10.8% (2 307) underwent surgery including 1652 cholecystectomies, 564 drainage procedures and 498 pancreatectomies. Procedures decreased from 12.1% to 8.3% over time (P  <  0.001), but intervention within 3  months increased (7.2% to 8.4%; P = 0.017). 15.3% (3 278) had @entity45 and 43.4% (9 312) had @entity6 . The median numbers of admissions were 2 [interquartile range (IQR) 1,5] and 3 (IQR 2,7) among non-surgical and surgical @entity1 , respectively (P  <  0.001). Predictors of surgery were fewer co-morbidities, private insurance, and either @entity6 or @entity45 . CONCLUSION: @entity1689 leads to numerous inpatient readmissions, but surgical intervention only occurs in a minority of cases. Complicated @entity1 are more likely to undergo surgery. The complexities of chronic @entity788 management warrant early multidisciplinary evaluation and ongoing consideration of surgical and non-surgical options.
