Abstract Rationale Acute cholecystitis (AC) is a leading cause of emergency hospitalizations and surgeries in the United States. While most cases are mild, complicated forms such as gangrenous cholecystitis can lead to systemic inflammation, sepsis, and multiorgan failure. These severe presentations increase the likelihood of acute respiratory distress syndrome and mortality. Invasive mechanical ventilation (MV) is frequently required for hypoxemia, airway protection, or peri-procedural management during cholecystectomy or ERCP. However, national data describing the epidemiology and predictors of MV use in AC remain limited. Methods We performed a retrospective cohort study using the Nationwide Inpatient Sample (NIS) from 2017-2022, representing a stratified sample of U. S. hospitalizations. Adult (≥18 years), non-elective admissions with a principal diagnosis of AC were identified using ICD-10-CM codes. Survey weights, strata, and primary sampling units provided by NIS were applied to generate national estimates. The primary outcome was the use of invasive MV during hospitalization. Multivariable survey-weighted logistic regression identified independent predictors of MV, adjusting for age, sex, race, Charlson comorbidity index, sepsis, elective admission status, weekend admission, hospital region, bed size, rural/urban designation, and teaching status. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were reported, and significance was defined as p0. 05. Results Among 283, 500 weighted adult AC admissions, 0. 86% (≈2, 430 discharges) required MV. Ventilated patients were older (mean 67. 3 vs. 59. 1 years; adjusted difference +8. 19 years, p0. 001) and had higher comorbidity burdens. Compared with Charlson index 0, adjusted odds of MV were 2. 57 for index 1, 3. 37 for index 2, and 5. 75 for index 3 (all p0. 001). Sepsis was the strongest independent predictor (aOR 17. 37, 95% CI 13. 68-22. 06; p0. 001). Large hospitals (500 beds) had higher odds of MV (aOR 1. 37; p=0. 027), while the West region had lower odds compared with the Northeast (aOR 0. 66; p=0. 028). Race, sex, teaching status, weekend, and rural admissions were not significant. MV use was associated with markedly higher resource utilization- mean length of stay 12. 9 vs. 3. 8 days and total charges 206, 881 vs. 57, 736 (p0. 001). Conclusions Mechanical ventilation in acute cholecystitis is primarily associated with older age, sepsis, and high comorbidity burden. The strong correlation between sepsis and MV underscores the role of systemic infection and organ failure in complicated AC, consistent with prior sepsis literature. These patients experience substantially longer hospitalizations and higher costs, highlighting the need for early recognition and management of sepsis in AC to prevent respiratory failure and reduce healthcare burden. This abstract is funded by: none
Phadke et al. (Fri,) studied this question.
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