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ERRATUM

Is It Safe to Manage Acute Cholecystitis Nonoperatively During Pregnancy? A Nationwide Analysis of Morbidity According to Management Strategy: Erratum

doi: 10.1097/SLA.0000000000004786
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In the September 2020 issue (272[3]:449-456) of Annals of Surgery, the article by Rios-Diaz et al., “Is It Safe to Manage Acute Cholecystitis Nonoperatively During Pregnancy? A Nationwide Analysis of Morbidity According to Management Strategy,” did not include the corrections requested by the corresponding author during the production process. The online version of the article has been updated to include all of the necessary changes, and we have provided a list of the important text corrections and revised versions of Figure 1 and the tables for the article below. Please note that updates were also made to the References in the article, and we refer readers to the updated online version of the article. The Publisher apologizes for these errors.

FIGURE 1
FIGURE 1:
Flow diagram of inclusion and exclusion criteria.

Page 449, paragraph 1 in abstract should read: “Objectives: To compare cholecystectomy (CCY) and nonoperative treatment (no-CCY) for acute cholecystitis in pregnancy.”

Page 449, paragraph 3 in abstract, lines 2-3 should read: “Propensity-score adjusted logistic regression models were used to compare CCY and no-CCY.”

Page 449, paragraph 4 in abstract, lines 2–3 should read: “Patients were more likely to be managed operatively in their second trimester (First 43.9%, Second 59.1%, Third 34.2%; P < 0.01).”

Page 450, first paragraph under heading “Outcome Measures,” lines 2–5 should read: “Complications were defined as stillbirth/intrauterine death, poor fetal growth, abortion, preterm delivery, C-section, obstetric bleeding, venous thromboembolism (deep venous thrombosis, obstetric and nonobstetric pulmonary embolism), and infection of the amniotic cavity.”

Page 450, first paragraph under heading “Outcome Measures,” lines 5–15 should read: “The secondary outcomes were in-hospital maternal mortality, neurological (stroke), cardiac (myocardial infarction, shock, heart failure, dysrhythmia), pulmonary (respiratory failure, pneumonia, aspiration pneumonitis), genitourinary complications (acute renal failure, urinary tract infection), blood transfusion, nonroutine discharge disposition (other than home under self-care), 30-day readmission (any type, unplanned [nonelective], planned [elective]), maternal-fetal composite upon 30-day readmission, index admission hospital LOS, and cumulative LOS.”

Page 450, first paragraph under heading “Outcome Measures,” lines 23–24 should read: “For the nonoperative group, the rate of cholecystectomy upon readmission (open and laparoscopic) was reported.”

Page 451, first paragraph, lines 9–14 should read: “The predicted mean differences in LOS with 95% CI for patients who were readmitted within 30 days were obtained through risk-adjusted generalized linear models with log link and Poisson distribution (determined by modified Park tests24) followed by post-estimation calculations of average marginal effects.”

Page 451, first paragraph under “Sensitivity Analyses,” lines 3–5 should read: “Another sensitivity analysis was performed only considering maternal-fetal complications when listed as other than primary and/or secondary diagnoses.”

TABLE 1 - Demographic, Clinical Mix, and Hospital Characteristics by Management Approach in a National Sample of Pregnant Patients Admitted With Acute Cholecystitis in the United States (Weighted Counts and Percentages)
Nonoperative Operative Overall
n = 3950 (61.8%) n = 2440 (38.2%) n = 6390 (100%)
Characteristic (Continuous) Mean SD Mean SD Mean SD P
Age 27.14 5.97 26.83 5.78 27.02 5.90 0.29
Gestational age 34.98 8.90 32.78 10.30 34.14 9.53 <0.01
Characteristic (Categorical) n % n % n % P
Insurance 0.44
 Public 2114 (53.5%) 1219 (50.0%) 3332 (52.2%)
 Private 1611 (40.8%) 1049 (43.0%) 2659 (41.6%)
 Self-pay 101 (2.6%) 65 (2.7%) 166 (2.6%)
 Other 126 (3.2%) 107 (4.4%) 233 (3.6%)
Income 0.17
 0–25th percentile 1383 (35.0%) 742 (30.4%) 2125 (33.3%)
 26th to 50th percentile (median) 993 (25.1%) 713 (29.2%) 1706 (26.7%)
 51st to 75th percentile 966 (24.4%) 643 (26.4%) 1609 (25.2%)
 76th to 100th percentile 609 (15.4%) 341 (14.0%) 950 (14.9%)
Same state resident 3866 (97.9%) 2406 (98.6%) 6272 (98.2%) 0.27
Charlson comorbidity index 0.8
 0–1 3885 (98.3%) 2403 (98.5%) 6288 (98.4%)
 >1 66 (1.7%) 37 (1.5%) 102 (1.6%)
Hypertension complicating pregnancy/preeclampsia/eclampsia 603 (15.3%) 224 (9.2%) 826 (12.9%) <0.01
Hypertension 216 (5.5%) 218 (9.0%) 434 (6.8%) 0.01
Gestational diabetes 277 (7.0%) 36 (1.5%) 313 (4.9%) <0.01
Diabetes 75 (1.9%) 59 (2.4%) 134 (2.1%) 0.48
Obese 412 (10.4%) 215 (8.8%) 627 (9.8%) 0.27
Smoker 493 (12.5%) 358 (14.7%) 851 (13.3%) 0.31
Drug abuse 156 (3.9%) 58 (2.4%) 214 (3.4%) 0.15
Trimester <0.01
 First 222 (5.6%) 173 (7.1%) 395 (6.2%)
 Second 348 (8.8%) 505 (20.7%) 853 (13.4%)
 Third 3381 (85.6%) 1762 (72.2%) 5142 (80.5%)
Previous C-section 429 (10.9%) 68 (2.8%) 496 (7.8%) <0.01
Multiple pregnancy 74 (1.9%) 38 (1.6%) 112 (1.8%) 0.67
Cervical incompetence 18 (0.5%) 0.86
Vulvovaginitis 16 (0.4%) 0.68
Sepsis 69 (1.8%) 77 (3.2%) 146 (2.3%) 0.1
Peritonitis 17 (0.4%) 45 (1.9%) 62 (1.0%) <0.01
Severity of illness 0.01
 Minor loss of function (includes cases with no comorbidity or complications) 233 (5.9%) 90 (3.7%) 323 (5.1%)
 Moderate loss of function 2506 (63.4%) 1730 (70.9%) 4236 (66.3%)
 Major/extreme loss of function 1212 (30.7%) 620 (25.4%) 1832 (28.7%)
Elective admission status 1335 (33.8%) 422 (17.3%) 1757 (27.5%) <0.01
Hospital ownership 0.25
 Government, nonfederal 598 (15.1%) 300 (12.3%) 898 (14.1%)
 Private, not-profit 2775 (70.3%) 1755 (71.9%) 4530 (70.9%)
 Private, invest-own 577 (14.6%) 385 (15.8%) 962 (15.1%)
Teaching hospital 1902 (48.2%) 1081 (44.3%) 2983 (46.7%) 0.19
Rural hospital 168 (4.2%) 73 (3.0%) 240 (3.8%) 0.07
Hospital bed size 0.23
 Small 520 (13.2%) 248 (10.2%) 768 (12.0%)
 Medium 1038 (26.3%) 628 (25.7%) 1666 (26.1%)
 Large 2393 (60.6%) 1564 (64.1%) 3957 (61.9%)
Cells with counts equal or less than 10 were suppressed as per HCUP data user agreement. Counts may not add up due to rounding of weighted counts.HCUP indicates Healthcare Cost and Utilization Project; SD, standard deviation.

TABLE 2 - Index Admission Adverse Outcomes in a National Sample of Pregnant Patients Admitted With Cholecystitis by Management Approach (Weighted Counts and Percentages)
Nonoperative Operative Overall Nonoperative (Ref. Operative)
n = 3950 (61.8%) n = 2440 (38.2%) n = 6390 (100%) Unadjusted Adjusted
Setting Outcome measure n (%) n (%) n (%) P OR 95% CI P OR 95% CI P
Outcomes during index admission Maternal-fetal complication composite 1091 (27.6%) 195 (8.0%) 1286 (20.1%) <0.01 4.38 (3.10 6.20) <0.01 3.00 (2.08 4.34) <0.01
 Intrauterine death/stillbirth 27 (0.7%) 14 (0.56%) 40 (0.6%) 0.73 1.22 (0.40 3.73) 0.73 0.75 (0.20 2.79) 0.67
 Poor fetal growth 69 (1.7%) <0.01 10.35 (1.92 55.71) 0.01 6.55 (1.09 39.50) 0.04
 Abortion 20 (0.8%) 0.09 0.28 (0.06 1.34) 0.11 0.36 (0.08 1.64) 0.19
 Preterm delivery 331 (8.4%) 52 (2.1%) 383 (6.0%) <0.01 4.23 (2.20 8.12) <0.01 3.26 (1.62 6.57) <0.01
 C-section 759 (19.2%) 99 (4.1%) 858 (13.4%) <0.01 5.60 (3.65 8.58) <0.01 3.18 (1.98 5.10) <0.01
 Obstetric bleeding 123 (3.1%) 40 (1.6%) 163 (2.5%) 0.04 1.94 (1.01 3.71) 0.045 1.57 (0.84 2.93) 0.16
 Venous thromboembolism 64 (1.6%) 19 (0.8%) 83 (1.3%) 0.13 2.07 (0.78 5.53) 0.14 2.39 (0.89 6.46) 0.09
 Infection of the amniotic cavity 42 (1.1%) 15 (0.6%) 58 (0.9%) 0.26 1.75 (0.65 4.68) 0.27 1.35 (0.40 4.50) 0.63
Mortality 0.34
Other complications 485 (12.3%) 334 (13.7%) 819 (12.8%) 0.43 0.88 (0.65 1.20) 0.43 0.87 (0.62 1.22) 0.42
 Neurological complications 0 (0.0%) 0 (0.0%) 0 (0.0%)
 Cardiac complications 55 (1.4%) 62 (2.5%) 116 (1.8%) 0.07 0.54 (0.28 1.08) 0.08 0.44 (0.18 1.08) 0.07
 Respiratory complications 87 (2.2%) 69 (2.8%) 156 (2.4%) 0.47 0.77 (0.38 1.57) 0.47 0.64 (0.28 1.49) 0.30
 Acute renal failure 93 (2.4%) 44 (1.8%) 137 (2.2%) 0.47 1.32 (0.62 2.81) 0.48 1.30 (0.57 2.96) 0.53
 Urinary tract infection 282 (7.1%) 205 (8.4%) 486 (7.6%) 0.33 0.84 (0.58 1.20) 0.33 0.97 (0.66 1.42) 0.88
 Blood transfusion 120 (3.0%) 72 (2.9%) 192 (3.0%) 0.91 1.03 (0.58 1.86) 0.91 0.80 (0.43 1.47) 0.46
Nonroutine discharge 241 (6.1%) 88 (3.6%) 329 (5.1%) 0.04 1.73 (1.02 2.95) 0.04 2.00 (1.13 3.53) 0.02
Unadjusted and adjusted propensity score-adjusted logistic regression models evaluating the association of adverse outcomes with nonoperative management of acute cholecystitis among pregnant women relative to operative management.
Cells with counts equal or less than 10 were suppressed as per the HCUP data user agreement. Counts may not add up due to rounding of weighted counts. Adjusted analyses controlled for propensity score based on age, insurance, income, Charlson Comorbidity Index, severity of illness, obesity, smoking status, hypertension complicating pregnancy (ie, preeclampsia, eclampsia), diabetes, gestational diabetes, previous C-section, gestational age, peritonitis, vulvovaginitis, cervical incompetence, elective admission status, hospital rural status, hospital bed size, and hospital teaching status.CI indicates confidence interval; HCUP, Healthcare Cost and Utilization Project; OR, odds ratio.

TABLE 3 - Adverse Outcomes Upon 30-d Readmission in a National Sample of Pregnant Patients Admitted With Cholecystitis by Management Approach (Weighted Counts and Percentages)
Nonoperative Operative Overall Nonoperative (Ref. Operative)
n = 3950 (61.8%) n = 2440 (38.2%) n = 6390 (100%) Unadjusted Adjusted
Setting Outcome measure n (%) n (%) n (%) P OR 95% CI P OR 95% CI P
Outcomes during 30-day readmission Readmission 30-d – any 739 (18.7%) 262 (10.7%) 1000 (15.7%) <0.01 1.92 (1.35 2.73) <0.01 1.91 (1.38 2.65) <0.01
 Different hospital (% among readmitted) 131 (17.8%) 67 (25.5%) 198 (19.8%) 0.21
Readmission 30-d – unplanned 474 (12.0%) 218 (8.9%) 692 (10.8%) 0.06 1.39 (0.98 1.98) 0.06 1.61 (1.12 2.32) <0.01
Readmission 30-d – planned 265 (6.7%) 41 (1.7%) 306 (4.8%) <0.01 4.23 (2.27 7.86) <0.01 3.03 (1.67 5.51) <0.01
Maternal-fetal complication composite 313 (7.9%) 89 (3.7%) 402 (6.3%) <0.01 2.27 (1.38 3.73) <0.01 1.96 (1.23 3.10) <0.01
 Intrauterine death/stillbirth 0.87 1.17 (0.17 8.21) 0.87 1.23 (0.21 7.09) 0.82
 Poor fetal growth 35 (0.9%) 14 (0.6%) 49 (0.8%) 0.65 1.48 (0.27 8.02) 0.65 1.43 (0.30 6.78) 0.65
 Abortion 0.99 1.01 (0.12 8.44) 0.99 1.20 (0.11 13.28) 0.88
 Preterm delivery 66 (1.7%) 39 (1.6%) 106 (1.7%) 0.91 1.04 (0.51 2.13) 0.91 1.06 (0.57 1.97) 0.87
 C-section 225 (5.7%) 48 (2.0%) 273 (4.3%) <0.01 2.99 (1.49 6.00) <0.01 2.34 (1.27 4.33) 0.01
 Obstetric bleeding 26 (0.7%) 0.28 1.97 (0.57 6.75) 0.28 1.51 (0.37 6.10) 0.57
 Venous thromboembolism 23 (0.6%) 18 (0.8%) 41 (0.7%) 0.64 0.78 (0.27 2.23) 0.64 1.07 (0.36 3.23) 0.90
 Infection of the amniotic cavity 12 (0.3%) 0.71 1.45 (0.21 10.17) 0.71 1.42 (0.22 9.25) 0.72
Delayed cholecystectomy 226 (5.7%)
Mortality 0.5
Unadjusted and adjusted propensity score-adjusted logistic regression models evaluating the association of adverse outcomes with nonoperative management of acute cholecystitis among pregnant women relative to operative management.
Cells with counts equal or less than 10 were suppressed as per the HCUP data user agreement. Counts may not add up due to rounding of weighted counts. Adjusted analyses controlled for propensity score based on age, insurance, income, Charlson Comorbidity Index, severity of illness, obesity, smoking status, hypertension complicating pregnancy (ie, preeclampsia, eclampsia), diabetes, gestational diabetes, previous C-section, gestational age, peritonitis, vulvovaginitis, cervical incompetence, elective admission status, hospital rural status, hospital bed size, and hospital teaching status.CI indicates confidence interval; HCUP, Healthcare Cost and Utilization Project; OR, odds ratio.

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