116 The Impact of Laparoscopic Cholecystectomy on 30-Day Readmission Rate for Acute Cholangitis Patients: A Single Center Study

Abstract

INTRODUCTION: Acute cholangitis is a serious inflammatory and infectious disease of the bile duct that requires prompt treatment. Choledocholithiasis is the main cause of acute cholangitis and requires biliary clearance using endoscopic retrograde cholangiopancreatography (ERCP). Following endoscopic clearance of the bile duct in patients with acute cholangitis, laparoscopic cholecystectomy (LC) is recommended for patients with gallstones. However, the timing of LC following acute cholangitis is still debatable. The aim of our study was to assess the impact of performing LC during admission following ERCP on the 30-day readmission rate. METHODS: A retrospective cohort study of acute cholangitis patients between April 2013 and May 2018. Patients were 18 years or older with a definite diagnosis of acute cholangitis based on Tokyo guidelines 2018. We only included acute cholangitis patients who underwent ERCP with complete clearance of the bile duct. Patients with malignant biliary strictures, a history of cholecystectomy, acute cholecystitis, intrahepatic ductal stones, primary sclerosing cholangitis, or cirrhosis were excluded. The primary outcome of the study was the 30-day readmission rate. RESULTS: A total of 95 patients with acute cholangitis were included in the study (Tables 1 and 2). Of these patients, 35 patients (36.8%) underwent LC during admission. The 30-day readmission rate was significantly lower in the LC group compared to the ERCP alone group (2.8% vs. 26.6%, P 0.003). There were no reported deaths in the LC group within 30 and 90 days of discharge, however the mortality rates in the ERCP alone group were 5.0% and 6.6%, respectively. In a multivariate analysis, performing LC during admission was an independent factor for 30-day readmission after adjusting for all other factors, where patients who underwent LC during admission had 90% less chance of readmission within 30 days (OR 0.1, 95% CI (0.01–0.86), P 0.03) (Table 2). CONCLUSION: Performing laparoscopic cholecystectomy during admission for acute cholangitis patients following endoscopic clearance of the bile duct was associated with a significant decrease (Absolute Reduction Rate 23.8%) in 30-day readmission rate. Several studies reported the safety of early LC in acute cholangitis patients as well as a decrease in the recurrence of biliary symptoms. Therefore, performing LC during admission should be recommended for acute cholangitis patients following endoscopic clearance of the bile duct.