Early Versus Late Laparoscopic Cholecystectomy in Patients with Acute Gallstone Pancreatitis

Abstract

The laparoscopic cholecystectomy is the definite treatment of acute gallstone pancreatitis, but the timing remains controversial. We aimed to evaluate trends, prevalence, and outcomes of laparoscopic cholecystectomy amongst patients with acute gallstone pancreatitis in index hospitalization done at different time intervals. We performed a retrospective study using Nationwide Inpatient Sample (years 2003–2014) with adult hospitalizations with acute gallstone pancreatitis who underwent laparoscopic cholecystectomy using ICD-9-CM codes and divided them into subgroups of those who underwent immediately (72 h), early (1 week), and delayed (> 1 week) laparoscopic cholecystectomy. The weighted analysis using chi-square, paired Wilcoxon-rank-sum test, Cochran-Armitage trend test, and multivariable survey logistic regression analysis was performed to evaluate prevalence and outcomes. There was a total of 582,406 acute gallstone pancreatitis admissions of which 291,701 (50.09%) patients had laparoscopic cholecystectomy (p < 0.0001). Prevalence of immediate laparoscopic cholecystectomy 114,629 (40.55%) showed incremental trend (32.61 to 49.82%) compared to early 149,931 (53.03%) (57.83 to 46.59%), and late laparoscopic cholecystectomy 18,158 (6.42%) (9.56 to 3.59%) from 2003 to 2014. Immediate and early laparoscopic cholecystectomy had lower prevalence and odds of mortality [0.24% versus 0.37% versus 2.46%; aOR-immediate: 0.614; aOR-early: 0.615; p < 0.0001], morbidity [1.36% versus 3.64% versus 27.57%; aOR-immediate: 0.088; aOR-early:0.161; p < 0.0001], disability [62.47% versus 70.15% versus 84.26%; aOR-immediate: 0.584; aOR-early: 0.68; p < 0.0001], discharge to non-home [7.07% versus 13.04% versus 31.84%; %; aOR-immediate: 0.346; aOR-early: 0.473; p < 0.0001], hospital cost $39,466 versus $52,018 versus $129,317 (p < 0.0001) and stay 3 days versus 6 days versus 19 days (p < 0.0001) than delayed laparoscopic cholecystectomy. The immediate laparoscopic cholecystectomy showed better outcomes; more prospective studies with large numbers of patients should be planned to evaluate the beneficial effects of immediate cholecystectomy in severe acute pancreatitis hospitalizations.