Same-Admission Cholecystectomy Compared with Delayed Cholecystectomy in Acute Gallstone Pancreatitis: Outcomes and Predictors in a Safety Net Hospital Cohort.

Abstract

Recent studies have shown a decrease in gallstone-related complications if same-admission cholecystectomy (SAC) is performed in mild gallstone pancreatitis (GSP); however, SAC often is not performed in resource-limited settings such as safety net hospitals. The aims of this study were to evaluate the rate of SAC and compare a composite endpoint of recurrent biliary events in patients undergoing SAC with patients in the delayed cholecystectomy (DC) group. Secondary aims included evaluating the rate of recurrent pancreatitis in patients in the DC group, identifying the predictors for DC and the reasons for not undergoing SAC. We reviewed 310 patients admitted in the past 5 years with the diagnosis of acute pancreatitis. Eighty patients were admitted for gallstone pancreatitis; 75% were African American, 18% were white, and the average age was 44 years with a mean body mass index of 30. Forty patients did not receive cholecystectomy before discharge. The DC and SAC groups were similar in body mass index, ethnicity, severity of pancreatitis, and complications. The DC group was significantly more likely to be older and with higher comorbidity indexes compared with the SAC group. Bedside Index of Severity in Acute Pancreatitis scores and revised Atlanta classification definitions were used to define severe acute pancreatitis; 10% (4) of patients had organ failure at 48 hours, whereas 17.5% (7) had a Bedside Index of Severity in Acute Pancreatitis scores ≥3. A total of 14 recurrent biliary events occurred in the DC group (14 of 40), which was 35% compared with 2 of 40 (5%) in the SAC group (P < 0.001). Of the 9 patients who developed recurrent pancreatitis, 8 were in the DC group (8 of 40, 20%, P = 0.02). Of the 40 patients in the DC group, only 14 patients eventually received a cholecystectomy documented in our hospital, with median-length postdischarge follow-up of approximately 6.5 months. On regression analysis, a Charlson Comorbidity Index >2 was the only significant predictor of DC. The most common reason for DC was no surgical consultation during the inpatient stay (22%). Our findings support existing evidence that DC is associated with a significantly increased risk of recurrent biliary events and pancreatitis. Furthermore, we report a 56% adherence to the current guidelines for SAC and report that the most common reason for not undergoing SAC was the absence of surgical consultation. We conclude that ensuring SAC in eligible patients should be a priority for safety net hospitals because it may help decrease hospital costs in the long term, and active efforts should be made to identify patients who may be less likely to receive SAC.