Clinical Characteristics and Hospital Outcomes of Gallbladder and Pancreatic Tuberculosis: Insights from the National Inpatient Sample Database

Clinical Characteristics and Hospital Outcomes of Gallbladder and Pancreatic Tuberculosis: Insights from the National Inpatient Sample Database | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Clinical Characteristics and Hospital Outcomes of Gallbladder and Pancreatic Tuberculosis: Insights from the National Inpatient Sample Database Mhd Kutaiba Albuni, Bisher Sawaf, Mohamad Hijazi, Tarek Aboursheid, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3894428/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Hepatobiliary and pancreatic tuberculosis (TB) are rare forms of extrapulmonary TB, posing challenges for diagnosis and management. This study utilizes the National Inpatient Sample (NIS) database to investigate the clinical characteristics and outcomes of patients with these conditions. We analyzed data from the NIS database (2016–2019) to identify patients with tuberculous pancreatitis and tuberculosis of the gallbladder. Categorical variables were summarized and compared using descriptive statistics and chi-square tests. Mean costs and standard deviations were calculated for financial assessment. The cohort consisted of 49 patients with diverse baseline characteristics and comorbidities. Medicare was the primary expected payer for most patients, and urban teaching hospitals were the common treatment setting. Hospital stays vary in length depending on factors such as primary payer, hospital teaching status, region, and bed size. Costs also varied and were highest in 2019. Medicaid had the highest mean cost among primary payers, while private insurance had the lowest. Urban teaching hospitals had higher mean costs compared to urban non-teaching hospitals. The West region had the highest mean cost, while the Northeast had the lowest. A larger hospital bed size was associated with higher costs. These findings contribute to understanding these rare manifestations of TB and can inform clinical decision-making and resource allocation. Health sciences/Gastroenterology/Gastrointestinal diseases Health sciences/Gastroenterology/Hepatology Health sciences/Diseases/Infectious diseases/Tuberculosis Figures Figure 1 Figure 2 INTRODUCTION Tuberculosis (TB) is a chronic infectious disease caused by a bacterium called Mycobacterium tuberculosis. It primarily affects the lungs, but it can also affect other organs in the body, leading to what is known as extrapulmonary TB. While pulmonary TB is more common, extrapulmonary TB accounts for around 15% of all TB cases [ 1 ]. Hepatobiliary and pancreatic TB are considered rare forms of extrapulmonary TB. These conditions involve the infection of the liver, bile ducts, gallbladder, and pancreas by the Mycobacterium tuberculosis bacterium. Diagnosing these forms of TB can be challenging due to their nonspecific clinical symptoms and radiological features, which can resemble other diseases [ 2 – 4 ]. To gain more insights into these rare manifestations of TB, our study was conducted using the National Inpatient Sample (NIS) database. The NIS is a comprehensive database that includes information on inpatient care from various hospitals across the United States. It represents a diverse range of patients and provides nationally representative estimates of hospitalizations and patient outcomes. This study aimed to investigate the clinical characteristics, management strategies, and outcomes of patients diagnosed with tuberculous pancreatitis (TB infection in the pancreas) and tuberculosis of the gallbladder. By analyzing the data from the NIS database, researchers aim to improve the understanding of these conditions and contribute to developing better diagnostic and management approaches. METHODS The objective of our study was to investigate the clinical characteristics, management strategies, and outcomes of patients diagnosed with tuberculous pancreatitis and gallbladder. We utilized data from the NIS database 2016-2019 to accomplish this. We employed the ICD-10 coding system to identify specific codes from the NIS database related to tuberculous gallbladder and tuberculous pancreatitis. We excluded records with missing values or those not meeting our predetermined inclusion criteria. Descriptive statistics were utilized to summarize continuous variables, providing an overview of key characteristics associated with tuberculous gallbladder and tuberculous pancreatitis. For categorical variables, we employed the chi-square test to identify any significant differences among the groups. Ethical approval for our study was not required, as we used de-identified data from the NIS database, which is publicly available and adheres to strict privacy regulations. RESULTS Baseline Characteristics: The 49 patients with pancreas/gallbladder TB cohort displayed diverse baseline characteristics and comorbidities. Among them, 26 were male and 23 were female, spanning various age groups, with the highest representation in the 40-year age group. The data covered years from 2016 to 2019. Medicare was the primary expected payer for the majority, followed by Medicaid and private insurance. Most patients received treatment at urban teaching hospitals in different regions, with a significant portion treated in large-sized hospitals. The patients' income quartiles varied across different ranges. Comorbidities such as hypertension, diabetes mellitus, chronic kidney disease, and anemia were observed, while certain conditions like systemic lupus erythematosus (SLE) had no reported cases. Overall, these baseline characteristics provide a snapshot of the diverse cohort and highlight key aspects for further analysis (S1) . Length of Hospital Stay: The mean length of stay ranged from 5 to 28 days, with standard deviations indicating variability around those means. Examining the data, certain patterns emerged: patients admitted in earlier years generally had more extended stays. Similarly, those with Medicaid as their primary payer had the highest mean length of stay. Hospitals in urban teaching settings generally had slightly shorter mean lengths of stay than urban non-teaching hospitals. Furthermore, the hospital region played a role, with patients in the South region experiencing longer stays compared to those in the Northeast, Midwest or North Central, and West regions. The bed size of the hospital also had an impact, as patients treated in larger hospitals tended to have longer stays compared to those in medium-sized and small-sized hospitals. Additionally, specific comorbidities such as human immunodeficiency virus (HIV) status and heart failure were associated with longer stays compared to other conditions. These findings shed light on the factors contributing to the length of hospital stay in the cohort and provide valuable insights for further analysis and clinical decision-making (S2) . Costs of Care: The mean costs vary across different categories. For example, the mean costs in 2019 were the highest at $ 51,513, with a large standard deviation of $ 107,692. In terms of the primary expected payer, Medicaid had the highest mean cost at $ 44,885, while private insurance had the lowest mean cost at $ 21,721. When considering the location/teaching status of the hospital, urban teaching hospitals had a higher mean cost of $ 36,579 compared to urban non-teaching hospitals with a mean cost of $ 28,381. The mean costs also differed by hospital region, with the West region having the highest mean cost of $ 70,030, while the Northeast region had the lowest mean cost at $ 18,185. Bed size also played a role in cost variation, as large-sized hospitals had the highest mean costs at $ 49,662, followed by medium-sized hospitals at $ 20,001 and small-sized hospitals at $ 11,572. ZIP income quartile analysis showed that the 51st-75th quartile had the highest mean costs at $ 53,395, while the 76th-100th quartile had the lowest mean costs at $ 16,983. Different comorbidities also exhibited varying mean costs, with heart failure (HF) having the highest mean cost of $ 100,453 and anemia having a mean cost of $ 29,766. ( S3) illustrates the mean costs of care according to different variables. Trends of Costs and Length of Stay across the Four Years: Our analysis did not reveal any significant trends for costs (p = 0.99) or length of stay (LOS) (p = 0.26) in relation to the investigated years. However, Figs. 1 and 2 depict a consistent linear curve across each year, suggesting a stable pattern of costs and LOS over the study period. DISCUSSION This study aimed to investigate the clinical characteristics and hospital outcomes of patients diagnosed with hepatobiliary and pancreatic TB using the NIS database. The data covered multiple years, from 2016 to 2019. The findings provide valuable insights into these rare manifestations of TB and contribute to developing better diagnostic and management approaches. A previously published systematic review included data on 166 patients [ 5 ], with a majority of them being males (62.1%) and a mean age of 41.61 ± 13.95 years. Our study, on the other hand, included a cohort of 49 patients with hepatobiliary and pancreatic TB, with a slightly more balanced gender distribution. The baseline characteristics of our cohort revealed diverse representations of age, with the highest representation in the 40-year age group. This aligns with the findings from the previous analysis, indicating that hepatobiliary and pancreatic TB can affect individuals across a wide age range. Diagnosing TB of the gallbladder and pancreas may pose significant challenges due to several factors. First, patients with pancreas or gallbladder TB often present with nonspecific symptoms that overlap with other diseases, such as gallbladder cancer or pancreatic cancer [ 3 , 6 ]. Similarly, abdominal imaging might be misleading as findings are similar to other diseases, making it difficult to differentiate between them radiologically [ 7 ]. In addition, TB of the gallbladder and pancreas is a rare disease, with involvement of the biliary tree or pancreas in abdominal tuberculosis cases limited to only 1% of cases [ 2 ]. This may be attributed to the fact that the pancreas exhibits a relatively high resistance to tuberculosis infection, secondary to the destructive action of pancreatic enzymes on mycobacteria [ 2 , 8 ]. Due to these factors, there might be a delay in diagnosing or a misdiagnosis, potentially resulting in a delay in initiating appropriate treatment and subsequent increases in the length of stay and costs [ 6 ]. In our study, the length of hospital stay varied within the cohort, with a mean length ranging from 5 to 28 days. Patients admitted in earlier years generally had longer stays, suggesting a possible improvement in managing these conditions over time. Furthermore, specific comorbidities, such as HIV status and heart failure, were associated with more extended hospital stays. We presume that those patients are more vulnerable and are among the sickest population, which extended their hospital stay in comparison to other patients with similar primary illnesses. These findings highlight the factors influencing the length of hospital stay in patients with hepatobiliary and pancreatic TB, which can inform clinical decision-making and resource allocation. Panic et al. reported an HIV infection rate of 25.3% among those affected [ 5 ]. In our cohort, HIV significantly negatively impacted the clinical course of pancreatic and hepatobiliary TB, resulting in an average hospital stay of 44 days for these patients. Concerning the primary payer, most patients had Medicare as their primary expected payer, followed by Medicaid and private insurance. Medicaid as the primary payer was associated with the highest mean length of stay, indicating potential disparities in access to care. Most patients received treatment at urban teaching hospitals in different regions, with a significant portion treated in large-sized hospitals. Urban teaching hospitals generally had slightly shorter mean lengths of stay than urban non-teaching hospitals, which may be attributed to the availability of specialized care and resources in teaching hospitals [ 9 , 10 ]. Urban teaching hospitals also had higher mean costs compared to urban non-teaching hospitals, possibly due to the complexity of cases and the availability of specialized services in teaching hospitals. Those results are similar to a published study that found teaching hospitals are costly compared to non-teaching hospitals [ 11 ]. Differences in mean costs were also observed across hospital regions, with the West region having the highest mean cost and the Northeast region having the lowest mean cost. Hospital bed size also influenced costs, with larger hospitals associated with higher mean costs. ZIP income quartile analysis showed varying mean costs across different income ranges, indicating potential disparities in healthcare utilization and costs [ 12 ]. Comorbidities also affected the cost, with heart failure having the highest mean cost. It is worth mentioning that this study has several limitations. Firstly, the analysis relied on retrospective data from the NIS database, which is subject to inherent limitations and potential biases. Secondly, using administrative data limits the availability of detailed clinical information, which may affect the accuracy and depth of the analysis. Thirdly, the study focused on inpatient care and did not capture outpatient or follow-up data, potentially missing important aspects of patient management and outcomes. Lastly, the study design is observational, and causality cannot be inferred. Further research is warranted to validate and expand upon these findings, preferably utilizing prospective and more detailed clinical data. Long-term follow-up studies and comprehensive cost-effectiveness analyses would provide a more thorough understanding of the impact and outcomes of hepatobiliary and pancreatic TB. Additionally, studies investigating optimal diagnostic and management strategies for these rare manifestations are needed to improve patient outcomes and reduce the burden of these conditions. CONCLUSION Using the NIS database, this study sheds light on the clinical characteristics, management strategies, and outcomes of patients with hepatobiliary and pancreatic TB. The findings contribute to understanding these rare manifestations of TB and provide insights for further research and clinical practice. These insights can guide healthcare professionals in optimizing the care and management of patients with hepatobiliary and pancreatic TB, ultimately improving patient outcomes. Declarations Credit authorship contribution statement: All authors contributed to the article equally. Declaration of Competing Interest The authors report no conflict of interest. Data availability statement: Nationwide Inpatient Sample (NIS) prior to 2019 data: The study examined regional cost differences of Pancreatic TB and TB of gallbladder admissions using discharge data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), and Agency for Healthcare Research and Quality. As per the Data Use Agreement for HCUP State Databases, sharing of the data is prohibited. References Bloom, B.R. , et al. Tuberculosis. in Major Infectious Diseases (eds. Holmes, K.K., Bertozzi, S., Bloom, B.R. & Jha, P.) (The International Bank for Reconstruction and Development / The World Bank © 2017 International Bank for Reconstruction and Development / The World Bank., Washington (DC), 2017). McMullan, G.S. & Lewis, J.H. Tuberculosis of the Liver, Biliary Tract, and Pancreas. Microbiol Spectr 5 (2017). Krishnamurthy, G. , et al. Gallbladder tuberculosis camouflaging as gallbladder cancer - case series and review focussing on treatment. Ther Adv Infect Dis 3 , 152-157 (2016). Saluja, S.S. , et al. Hepatobiliary and pancreatic tuberculosis: a two decade experience. BMC Surg 7 , 10 (2007). Panic, N., Maetzel, H., Bulajic, M., Radovanovic, M. & Löhr, J.M. Pancreatic tuberculosis: A systematic review of symptoms, diagnosis and treatment. United European Gastroenterol J 8 , 396-402 (2020). Jørstad, M.D., Aẞmus, J., Marijani, M., Sviland, L. & Mustafa, T. Diagnostic delay in extrapulmonary tuberculosis and impact on patient morbidity: A study from Zanzibar. PLoS One 13 , e0203593 (2018). Nagar, A.M. , et al. Pancreatic tuberculosis: a clinical and imaging review of 32 cases. J Comput Assist Tomogr 33 , 136-141 (2009). Chaudhary, P., Bhadana, U. & Arora, M.P. Pancreatic Tuberculosis. Indian J Surg 77 , 517-524 (2015). Scherer, L.C. , et al. Cost-effectiveness analysis of PCR for the rapid diagnosis of pulmonary tuberculosis. BMC Infect Dis 9 , 216 (2009). Vassall, A. , et al. Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis. PLoS Med 8 , e1001120 (2011). Burke, L.G. , et al. Comparison of Costs of Care for Medicare Patients Hospitalized in Teaching and Nonteaching Hospitals. JAMA Netw Open 2 , e195229 (2019). Himmelstein, D.U., Campbell, T. & Woolhandler, S. Health Care Administrative Costs in the United States and Canada, 2017. Ann Intern Med 172 , 134-142 (2020). Additional Declarations No competing interests reported. Supplementary Files Tables.docx Supplementary tables: S1: Baseline Characteristics and Comorbidities. S2: Mean Length of hospital stay. S3: Costs of Hospital Care in Dollar. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3894428","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":272749660,"identity":"2e09f478-c876-4590-8568-41b0eab77c6a","order_by":0,"name":"Mhd Kutaiba Albuni","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYDACCQYDxgYgzSbBwPgASPPwEanFAKSF2QCkhY1oLUAGUBfIOkI6dGc3b2Cc2fZHnk+6+Vnl1xw7GTYG5oePbuDRYnbnWAHjxjYDwzaZY2a3ZbclAx3GZmycg0/LjRwDxodtBoxtEglmtyW3MQO18LBJE6PFvk0i/Vux5LZ6IrUAHZbYJpFjxvhx22FitKQVHJxxzji5TeZMsTTjtuM8bMwE/ZK88WFPmZzt/NntGz/+3FZtz8/e/PAxPi0gcADGYOYBkwSUowDGH6SoHgWjYBSMghEDAEBJRda4vQw1AAAAAElFTkSuQmCC","orcid":"","institution":"TriHealth Good Samaritan Hospital","correspondingAuthor":true,"prefix":"","firstName":"Mhd","middleName":"Kutaiba","lastName":"Albuni","suffix":""},{"id":272749661,"identity":"4420aee7-871e-41a9-9909-921ac4a07b19","order_by":1,"name":"Bisher Sawaf","email":"","orcid":"","institution":"Hamad Medical Corporation","correspondingAuthor":false,"prefix":"","firstName":"Bisher","middleName":"","lastName":"Sawaf","suffix":""},{"id":272749662,"identity":"23e68333-5bbb-4586-b4dc-a505e1f3be1d","order_by":2,"name":"Mohamad Hijazi","email":"","orcid":"","institution":"TriHealth Good Samaritan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mohamad","middleName":"","lastName":"Hijazi","suffix":""},{"id":272749663,"identity":"774d4d4e-5241-465a-afe4-ff2ba8054cfa","order_by":3,"name":"Tarek Aboursheid","email":"","orcid":"","institution":"Ascension Saint Francis Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tarek","middleName":"","lastName":"Aboursheid","suffix":""},{"id":272749664,"identity":"9fc6ddc2-f25b-4f70-9b7c-c6286240842d","order_by":4,"name":"Shahem Abbarh","email":"","orcid":"","institution":"Hamad Medical Corporation","correspondingAuthor":false,"prefix":"","firstName":"Shahem","middleName":"","lastName":"Abbarh","suffix":""},{"id":272749665,"identity":"ee5971cb-5ed9-4637-9606-5b1e0e29f6ce","order_by":5,"name":"Adnan Hajjar","email":"","orcid":"","institution":"Hamad Medical Corporation","correspondingAuthor":false,"prefix":"","firstName":"Adnan","middleName":"","lastName":"Hajjar","suffix":""},{"id":272749666,"identity":"1cf17438-25dd-4800-8049-8e2d4ebbb8a1","order_by":6,"name":"Mhd Amin Alzabibi","email":"","orcid":"","institution":"Uppsala University","correspondingAuthor":false,"prefix":"","firstName":"Mhd","middleName":"Amin","lastName":"Alzabibi","suffix":""},{"id":272749667,"identity":"6d2c47cc-0981-441e-b76b-27fe199bc4e4","order_by":7,"name":"Mosa Shibani","email":"","orcid":"","institution":"University of Glasgow","correspondingAuthor":false,"prefix":"","firstName":"Mosa","middleName":"","lastName":"Shibani","suffix":""},{"id":272749668,"identity":"6d8d7f8d-7fe8-43bb-af24-da18ff216d24","order_by":8,"name":"Obada Daaboul","email":"","orcid":"","institution":"Southern Illinois University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Obada","middleName":"","lastName":"Daaboul","suffix":""},{"id":272749669,"identity":"4b061797-77e1-4d5f-939e-16e4cbf8b83b","order_by":9,"name":"Khalid M. 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It primarily affects the lungs, but it can also affect other organs in the body, leading to what is known as extrapulmonary TB. While pulmonary TB is more common, extrapulmonary TB accounts for around 15% of all TB cases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHepatobiliary and pancreatic TB are considered rare forms of extrapulmonary TB. These conditions involve the infection of the liver, bile ducts, gallbladder, and pancreas by the Mycobacterium tuberculosis bacterium. Diagnosing these forms of TB can be challenging due to their nonspecific clinical symptoms and radiological features, which can resemble other diseases [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo gain more insights into these rare manifestations of TB, our study was conducted using the National Inpatient Sample (NIS) database. The NIS is a comprehensive database that includes information on inpatient care from various hospitals across the United States. It represents a diverse range of patients and provides nationally representative estimates of hospitalizations and patient outcomes.\u003c/p\u003e \u003cp\u003eThis study aimed to investigate the clinical characteristics, management strategies, and outcomes of patients diagnosed with tuberculous pancreatitis (TB infection in the pancreas) and tuberculosis of the gallbladder. By analyzing the data from the NIS database, researchers aim to improve the understanding of these conditions and contribute to developing better diagnostic and management approaches.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThe objective of our study was to investigate the clinical characteristics, management strategies, and outcomes of patients diagnosed with tuberculous pancreatitis and gallbladder. We utilized data from the NIS database 2016-2019 to accomplish this.\u003c/p\u003e\n\u003cp\u003eWe employed the ICD-10 coding system to identify specific codes from the NIS database related to tuberculous gallbladder and tuberculous pancreatitis. We excluded records with missing values or those not meeting our predetermined inclusion criteria.\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were utilized to summarize continuous variables, providing an overview of key characteristics associated with tuberculous gallbladder and tuberculous pancreatitis. For categorical variables, we employed the chi-square test to identify any significant differences among the groups.\u003c/p\u003e\n\u003cp\u003eEthical approval for our study was not required, as we used de-identified data from the NIS database, which is publicly available and adheres to strict privacy regulations.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eBaseline Characteristics:\u003c/h2\u003e \u003cp\u003eThe 49 patients with pancreas/gallbladder TB cohort displayed diverse baseline characteristics and comorbidities. Among them, 26 were male and 23 were female, spanning various age groups, with the highest representation in the 40-year age group. The data covered years from 2016 to 2019. Medicare was the primary expected payer for the majority, followed by Medicaid and private insurance. Most patients received treatment at urban teaching hospitals in different regions, with a significant portion treated in large-sized hospitals. The patients' income quartiles varied across different ranges. Comorbidities such as hypertension, diabetes mellitus, chronic kidney disease, and anemia were observed, while certain conditions like systemic lupus erythematosus (SLE) had no reported cases. Overall, these baseline characteristics provide a snapshot of the diverse cohort and highlight key aspects for further analysis \u003cb\u003e(S1)\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eLength of Hospital Stay:\u003c/h2\u003e \u003cp\u003eThe mean length of stay ranged from 5 to 28 days, with standard deviations indicating variability around those means. Examining the data, certain patterns emerged: patients admitted in earlier years generally had more extended stays. Similarly, those with Medicaid as their primary payer had the highest mean length of stay. Hospitals in urban teaching settings generally had slightly shorter mean lengths of stay than urban non-teaching hospitals. Furthermore, the hospital region played a role, with patients in the South region experiencing longer stays compared to those in the Northeast, Midwest or North Central, and West regions. The bed size of the hospital also had an impact, as patients treated in larger hospitals tended to have longer stays compared to those in medium-sized and small-sized hospitals. Additionally, specific comorbidities such as human immunodeficiency virus (HIV) status and heart failure were associated with longer stays compared to other conditions. These findings shed light on the factors contributing to the length of hospital stay in the cohort and provide valuable insights for further analysis and clinical decision-making \u003cb\u003e(S2)\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eCosts of Care:\u003c/h2\u003e \u003cp\u003eThe mean costs vary across different categories. For example, the mean costs in 2019 were the highest at \u003cspan\u003e$\u003c/span\u003e51,513, with a large standard deviation of \u003cspan\u003e$\u003c/span\u003e107,692. In terms of the primary expected payer, Medicaid had the highest mean cost at \u003cspan\u003e$\u003c/span\u003e44,885, while private insurance had the lowest mean cost at \u003cspan\u003e$\u003c/span\u003e21,721. When considering the location/teaching status of the hospital, urban teaching hospitals had a higher mean cost of \u003cspan\u003e$\u003c/span\u003e36,579 compared to urban non-teaching hospitals with a mean cost of \u003cspan\u003e$\u003c/span\u003e28,381. The mean costs also differed by hospital region, with the West region having the highest mean cost of \u003cspan\u003e$\u003c/span\u003e70,030, while the Northeast region had the lowest mean cost at \u003cspan\u003e$\u003c/span\u003e18,185.\u003c/p\u003e \u003cp\u003eBed size also played a role in cost variation, as large-sized hospitals had the highest mean costs at \u003cspan\u003e$\u003c/span\u003e49,662, followed by medium-sized hospitals at \u003cspan\u003e$\u003c/span\u003e20,001 and small-sized hospitals at \u003cspan\u003e$\u003c/span\u003e11,572. ZIP income quartile analysis showed that the 51st-75th quartile had the highest mean costs at \u003cspan\u003e$\u003c/span\u003e53,395, while the 76th-100th quartile had the lowest mean costs at \u003cspan\u003e$\u003c/span\u003e16,983. Different comorbidities also exhibited varying mean costs, with heart failure (HF) having the highest mean cost of \u003cspan\u003e$\u003c/span\u003e100,453 and anemia having a mean cost of \u003cspan\u003e$\u003c/span\u003e29,766. (\u003cb\u003eS3)\u003c/b\u003e illustrates the mean costs of care according to different variables.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eTrends of Costs and Length of Stay across the Four Years:\u003c/h2\u003e \u003cp\u003eOur analysis did not reveal any significant trends for costs (p\u0026thinsp;=\u0026thinsp;0.99) or length of stay (LOS) (p\u0026thinsp;=\u0026thinsp;0.26) in relation to the investigated years. However, \u003cb\u003eFigs.\u0026nbsp;1 and 2\u003c/b\u003e depict a consistent linear curve across each year, suggesting a stable pattern of costs and LOS over the study period.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study aimed to investigate the clinical characteristics and hospital outcomes of patients diagnosed with hepatobiliary and pancreatic TB using the NIS database. The data covered multiple years, from 2016 to 2019. The findings provide valuable insights into these rare manifestations of TB and contribute to developing better diagnostic and management approaches.\u003c/p\u003e \u003cp\u003eA previously published systematic review included data on 166 patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], with a majority of them being males (62.1%) and a mean age of 41.61\u0026thinsp;\u0026plusmn;\u0026thinsp;13.95 years. Our study, on the other hand, included a cohort of 49 patients with hepatobiliary and pancreatic TB, with a slightly more balanced gender distribution. The baseline characteristics of our cohort revealed diverse representations of age, with the highest representation in the 40-year age group. This aligns with the findings from the previous analysis, indicating that hepatobiliary and pancreatic TB can affect individuals across a wide age range.\u003c/p\u003e \u003cp\u003eDiagnosing TB of the gallbladder and pancreas may pose significant challenges due to several factors. First, patients with pancreas or gallbladder TB often present with nonspecific symptoms that overlap with other diseases, such as gallbladder cancer or pancreatic cancer [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Similarly, abdominal imaging might be misleading as findings are similar to other diseases, making it difficult to differentiate between them radiologically [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In addition, TB of the gallbladder and pancreas is a rare disease, with involvement of the biliary tree or pancreas in abdominal tuberculosis cases limited to only 1% of cases [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This may be attributed to the fact that the pancreas exhibits a relatively high resistance to tuberculosis infection, secondary to the destructive action of pancreatic enzymes on mycobacteria [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Due to these factors, there might be a delay in diagnosing or a misdiagnosis, potentially resulting in a delay in initiating appropriate treatment and subsequent increases in the length of stay and costs [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, the length of hospital stay varied within the cohort, with a mean length ranging from 5 to 28 days. Patients admitted in earlier years generally had longer stays, suggesting a possible improvement in managing these conditions over time. Furthermore, specific comorbidities, such as HIV status and heart failure, were associated with more extended hospital stays. We presume that those patients are more vulnerable and are among the sickest population, which extended their hospital stay in comparison to other patients with similar primary illnesses. These findings highlight the factors influencing the length of hospital stay in patients with hepatobiliary and pancreatic TB, which can inform clinical decision-making and resource allocation. Panic et al. reported an HIV infection rate of 25.3% among those affected [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In our cohort, HIV significantly negatively impacted the clinical course of pancreatic and hepatobiliary TB, resulting in an average hospital stay of 44 days for these patients. Concerning the primary payer, most patients had Medicare as their primary expected payer, followed by Medicaid and private insurance. Medicaid as the primary payer was associated with the highest mean length of stay, indicating potential disparities in access to care. Most patients received treatment at urban teaching hospitals in different regions, with a significant portion treated in large-sized hospitals. Urban teaching hospitals generally had slightly shorter mean lengths of stay than urban non-teaching hospitals, which may be attributed to the availability of specialized care and resources in teaching hospitals [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUrban teaching hospitals also had higher mean costs compared to urban non-teaching hospitals, possibly due to the complexity of cases and the availability of specialized services in teaching hospitals. Those results are similar to a published study that found teaching hospitals are costly compared to non-teaching hospitals [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Differences in mean costs were also observed across hospital regions, with the West region having the highest mean cost and the Northeast region having the lowest mean cost. Hospital bed size also influenced costs, with larger hospitals associated with higher mean costs. ZIP income quartile analysis showed varying mean costs across different income ranges, indicating potential disparities in healthcare utilization and costs [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Comorbidities also affected the cost, with heart failure having the highest mean cost.\u003c/p\u003e \u003cp\u003eIt is worth mentioning that this study has several limitations. Firstly, the analysis relied on retrospective data from the NIS database, which is subject to inherent limitations and potential biases. Secondly, using administrative data limits the availability of detailed clinical information, which may affect the accuracy and depth of the analysis. Thirdly, the study focused on inpatient care and did not capture outpatient or follow-up data, potentially missing important aspects of patient management and outcomes. Lastly, the study design is observational, and causality cannot be inferred.\u003c/p\u003e \u003cp\u003eFurther research is warranted to validate and expand upon these findings, preferably utilizing prospective and more detailed clinical data. Long-term follow-up studies and comprehensive cost-effectiveness analyses would provide a more thorough understanding of the impact and outcomes of hepatobiliary and pancreatic TB. Additionally, studies investigating optimal diagnostic and management strategies for these rare manifestations are needed to improve patient outcomes and reduce the burden of these conditions.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eUsing the NIS database, this study sheds light on the clinical characteristics, management strategies, and outcomes of patients with hepatobiliary and pancreatic TB. The findings contribute to understanding these rare manifestations of TB and provide insights for further research and clinical practice. These insights can guide healthcare professionals in optimizing the care and management of patients with hepatobiliary and pancreatic TB, ultimately improving patient outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCredit authorship contribution statement:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the article equally.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDeclaration of Competing Interest\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNationwide Inpatient Sample (NIS) prior to 2019 data:\u003c/p\u003e\n\u003cp\u003eThe study examined regional cost differences of Pancreatic TB and TB of gallbladder admissions using discharge data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), and Agency for Healthcare Research and Quality. As per the Data Use Agreement for HCUP State Databases, sharing of the data is prohibited.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBloom, B.R.\u003cem\u003e, et al.\u003c/em\u003e Tuberculosis. in \u003cem\u003eMajor Infectious Diseases\u003c/em\u003e (eds. Holmes, K.K., Bertozzi, S., Bloom, B.R. \u0026amp; Jha, P.) (The International Bank for Reconstruction and Development / The World Bank \u0026copy; 2017 International Bank for Reconstruction and Development / The World Bank., Washington (DC), 2017).\u003c/li\u003e\n\u003cli\u003eMcMullan, G.S. \u0026amp; Lewis, J.H. Tuberculosis of the Liver, Biliary Tract, and Pancreas. \u003cem\u003eMicrobiol Spectr\u003c/em\u003e \u003cstrong\u003e5\u003c/strong\u003e(2017).\u003c/li\u003e\n\u003cli\u003eKrishnamurthy, G.\u003cem\u003e, et al.\u003c/em\u003e Gallbladder tuberculosis camouflaging as gallbladder cancer - case series and review focussing on treatment. \u003cem\u003eTher Adv Infect Dis\u003c/em\u003e \u003cstrong\u003e3\u003c/strong\u003e, 152-157 (2016).\u003c/li\u003e\n\u003cli\u003eSaluja, S.S.\u003cem\u003e, et al.\u003c/em\u003e Hepatobiliary and pancreatic tuberculosis: a two decade experience. \u003cem\u003eBMC Surg\u003c/em\u003e \u003cstrong\u003e7\u003c/strong\u003e, 10 (2007).\u003c/li\u003e\n\u003cli\u003ePanic, N., Maetzel, H., Bulajic, M., Radovanovic, M. \u0026amp; L\u0026ouml;hr, J.M. Pancreatic tuberculosis: A systematic review of symptoms, diagnosis and treatment. \u003cem\u003eUnited European Gastroenterol J\u003c/em\u003e \u003cstrong\u003e8\u003c/strong\u003e, 396-402 (2020).\u003c/li\u003e\n\u003cli\u003eJ\u0026oslash;rstad, M.D., Aẞmus, J., Marijani, M., Sviland, L. \u0026amp; Mustafa, T. Diagnostic delay in extrapulmonary tuberculosis and impact on patient morbidity: A study from Zanzibar. \u003cem\u003ePLoS One\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, e0203593 (2018).\u003c/li\u003e\n\u003cli\u003eNagar, A.M.\u003cem\u003e, et al.\u003c/em\u003e Pancreatic tuberculosis: a clinical and imaging review of 32 cases. \u003cem\u003eJ Comput Assist Tomogr\u003c/em\u003e \u003cstrong\u003e33\u003c/strong\u003e, 136-141 (2009).\u003c/li\u003e\n\u003cli\u003eChaudhary, P., Bhadana, U. \u0026amp; Arora, M.P. Pancreatic Tuberculosis. \u003cem\u003eIndian J Surg\u003c/em\u003e \u003cstrong\u003e77\u003c/strong\u003e, 517-524 (2015).\u003c/li\u003e\n\u003cli\u003eScherer, L.C.\u003cem\u003e, et al.\u003c/em\u003e Cost-effectiveness analysis of PCR for the rapid diagnosis of pulmonary tuberculosis. \u003cem\u003eBMC Infect Dis\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 216 (2009).\u003c/li\u003e\n\u003cli\u003eVassall, A.\u003cem\u003e, et al.\u003c/em\u003e Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis. \u003cem\u003ePLoS Med\u003c/em\u003e \u003cstrong\u003e8\u003c/strong\u003e, e1001120 (2011).\u003c/li\u003e\n\u003cli\u003eBurke, L.G.\u003cem\u003e, et al.\u003c/em\u003e Comparison of Costs of Care for Medicare Patients Hospitalized in Teaching and Nonteaching Hospitals. \u003cem\u003eJAMA Netw Open\u003c/em\u003e \u003cstrong\u003e2\u003c/strong\u003e, e195229 (2019).\u003c/li\u003e\n\u003cli\u003eHimmelstein, D.U., Campbell, T. \u0026amp; Woolhandler, S. Health Care Administrative Costs in the United States and Canada, 2017. \u003cem\u003eAnn Intern Med\u003c/em\u003e \u003cstrong\u003e172\u003c/strong\u003e, 134-142 (2020).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3894428/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3894428/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eHepatobiliary and pancreatic tuberculosis (TB) are rare forms of extrapulmonary TB, posing challenges for diagnosis and management. This study utilizes the National Inpatient Sample (NIS) database to investigate the clinical characteristics and outcomes of patients with these conditions. We analyzed data from the NIS database (2016\u0026ndash;2019) to identify patients with tuberculous pancreatitis and tuberculosis of the gallbladder. Categorical variables were summarized and compared using descriptive statistics and chi-square tests. Mean costs and standard deviations were calculated for financial assessment. The cohort consisted of 49 patients with diverse baseline characteristics and comorbidities. Medicare was the primary expected payer for most patients, and urban teaching hospitals were the common treatment setting. Hospital stays vary in length depending on factors such as primary payer, hospital teaching status, region, and bed size. Costs also varied and were highest in 2019. Medicaid had the highest mean cost among primary payers, while private insurance had the lowest. Urban teaching hospitals had higher mean costs compared to urban non-teaching hospitals. The West region had the highest mean cost, while the Northeast had the lowest. A larger hospital bed size was associated with higher costs. These findings contribute to understanding these rare manifestations of TB and can inform clinical decision-making and resource allocation.\u003c/p\u003e","manuscriptTitle":"Clinical Characteristics and Hospital Outcomes of Gallbladder and Pancreatic Tuberculosis: Insights from the National Inpatient Sample Database","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-14 18:35:50","doi":"10.21203/rs.3.rs-3894428/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"43557ebd-581b-4aae-a30f-d4c054b7516a","owner":[],"postedDate":"February 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":28748946,"name":"Health sciences/Gastroenterology/Gastrointestinal diseases"},{"id":28748947,"name":"Health sciences/Gastroenterology/Hepatology"},{"id":28748948,"name":"Health sciences/Diseases/Infectious diseases/Tuberculosis"}],"tags":[],"updatedAt":"2024-12-10T07:09:26+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-14 18:35:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3894428","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3894428","identity":"rs-3894428","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}