S105 Academic Advantage? Evaluating Acute Cholangitis Outcomes by Hospital Teaching Status: A Nationwide Propensity Score Analysis

Introduction: Acute cholangitis is a serious condition caused by partial or complete obstruction of the common bile duct, leading to biliary tract infection. We aimed to evaluate whether teaching hospitals with trainees and nonteaching hospitals impact the outcome of acute cholangitis in the United States. Methods: This study utilized the National Inpatient Sample database to analyze adult hospitalizations with a primary diagnosis of acute cholangitis in the United States from 2016 to 2020. A multivariate logistic regression along with chi-square and T-test were performed using SAS 9.4 software to analyze inpatient acute cholangitis-associated mortality, inflation-adjusted total hospital charge, length of stay, incidence of septic shock, need for ICU, intubation, CVC placement as well as endoscopic retrograde cholangiopancreatography utilization in United States teaching and non-teaching hospitals during the study period. Results: This study included a total of 30,300 patients, out of them 23,535 (∼78%) were managed in teaching hospitals and 6,765 (∼22%) were managed in non-teaching hospitals. Primary outcomes showed a significant increase in mortality for patients managed in teaching hospitals (2.77% vs 2.08%, P = 0.01) in comparison to non-teaching hospitals, hospital length of stay was slightly higher in teaching hospitals (5 days (IQR: 3-6) vs 4 days (IQR: 3-8)) and so did hospital cost ($15,259 vs $14,506) in comparison to non-teaching hospitals. Secondary outcomes showed patients in teaching hospitals had higher incidence of septic shock (16.06% vs 12.53%, P < 0.0001), ICU admissions (6.61% vs 5.07%, P = 0.0002), intubation (5.30% vs 3.46%, P < 0.0001) in comparison to non-teaching hospitals. However, there was no significant difference found in between 2 groups for CVC placement and endoscopic retrograde cholangiopancreatography utilization. Conclusion: Our study found higher mortality rates for acute cholangitis patients in teaching hospitals compared to non-teaching hospitals. Teaching hospitals also had higher rates of septic shock, ICU admission, and intubation, with no difference in endoscopic retrograde cholangiopancreatography use. These differences could be due to several factors, such as greater resident and fellow autonomy in teaching hospitals and a potentially more proactive approach by physicians in non-teaching hospitals. Additionally, teaching hospitals often manage more complex, higher-acuity cases, which could contribute to worse outcomes.