An Urban-Rural Blight? Choledocholithiasis Presentation and Treatment

Background Exploration of urban-rural (UR) and regional differences is critical to developing effective healthcare delivery systems. Choledocholithiasis (CDL) remains a common problem with a range of therapeutic options and potentially severe complications. This study evaluated UR and regional differences of CDL presentation and treatment. We hypothesized that UR status contributes to differences in treatment of CDL. Methods This study examined patients from the 2007 Healthcare Cost and Utilization Project dataset. Inpatient discharges and interventions for CDL patients were identified. UR and regional designations were determined from National Center for Health Statistics guidelines. Patients with pancreatitis or cholangitis were designated as complicated CDL (cCDL) patients. Interventions for CDL were classified as endoscopic, surgical, or percutaneous. Complex-sample proportion analyses were performed. Results A total of 111,021 patients with CDL were identified; 81% of these patients lived in urban areas compared with 19% in rural areas; 61% had uncomplicated choledocholithiasis (uCDL) and 39% had cCDL. The overall distribution of uCDL and cCDL did not differ by UR status or region. A higher proportion of rural patients did not receive an intervention 45.1% (95%CI 41.8%–48.4%) versus urban patients 30.5% (28.8%–32.2%), P < 0.05. Interventions for urban patients were more likely endoscopic 87.7% (86.8%–88.6%) compared with rural 82.0% (79.3%–84.7%), P < 0.05. Rural patients were more likely to undergo surgery 10.5% (8.6%–12.4%) than urban patients 4.9% (4.4%–5.4%), P < 0.05. Regional variations did not impact the type of intervention received. Conclusion Rural patients received CDL interventions less often and had a higher proportion of surgical interventions regardless of severity of presentation.