More Evidence for Early Cholecystectomy After Gallstone Pancreatitis

Same-admission cholecystectomy is recommended for patients with mild gallstone pancreatitis (GSP) to reduce recurrent GSP events and lower costs. However, adherence to same-admission cholecystectomy remains suboptimal, with less than half of patients undergoing early cholecystectomy in some studies. 

The authors of this retrospective study used the Nationwide Readmissions Database to identify 129,251 patients from 2016 to 2019 who had mild GSP and underwent cholecystectomy within 2 weeks of admission. The primary outcome was major adverse events (30-day mortality and perioperative complications). 

Early cholecystectomy, defined for this study as occurring within 2 days of admission, was performed in a small proportion of patients (25.7%); the remainder underwent late cholecystectomy. Although typical factors were associated with late versus early cholecystectomy (e.g., older age and more comorbidities), other nonclinical factors associated with late cholecystectomy included lower-income insurance type and presentation to a high-volume hospital.  

After risk adjustment, patients who underwent late cholecystectomy had a higher risk of major adverse events (adjusted odds ratio, 1.40; 95% confidence interval, 1.24-1.51). Furthermore, as would be expected, late cholecystectomy was associated with higher costs and, interestingly, increased 30-day nonelective readmission rates. 

Further subgroup analysis identified that hospitals with a high volume of cholecystectomy procedures had improved outcomes regardless of operative timing. Preoperative ERCP was performed more frequently in the late cholecystectomy group (22.2%) than in the early cholecystectomy group (10.9%).