D0018 - Early Cholecystectomy Improves Clinical Outcomes in Acute Biliary Pancreatitis Patients Across All Age Groups: A Multicenter Retrospective Study

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

RS

Ritu R. Singh, MD

Indiana University School of Medicine
Fort Wayne, Indiana

Ritu R. Singh, MD¹, Nikhil A. Kumta, MD, MS²
¹Indiana University School of Medicine, Fort Wayne, IN; ²Icahn School of Medicine at Mount Sinai, New York, NY

Introduction: Gall stone disease is the most common etiology of acute pancreatitis accounting for 40-70% of all cases. Cholecystectomy is recommended early in patients with acute biliary pancreatitis (ABP) to prevent a recurrence. Elderly patients have a higher incidence of the disease and are at risk of worse outcomes, however, this cohort has not been studied adequately. Thus, we aim to study the outcomes of patients who undergo early cholecystectomy versus those who do not.

Methods: This is a retrospective, multicenter cohort study utilizing TriNetX (Cambridge, MA), “a global federated health research network”. Adult patients with ABP were identified using appropriate ICD-10 CM codes and divided into two groups, younger than 70 and those who are 70 and older. Within each group, a cohort of patients who had an early cholecystectomy (within 2 weeks) was compared with patients who did not have early cholecystectomy. The primary outcomes were 90-day mortality and 90-day re-hospitalization.

Results: A total of 30,062 adults (9,728 elderly) with ABP were identified and 13,574 (45%) of them underwent early cholecystectomy. Among younger patients (< 70 years), approximately 49% underwent early cholecystectomy, while 36% of the elderly patients underwent early cholecystectomy. After propensity score matching, younger patients (< 70 years) who had early cholecystectomy experienced lower 90-day (RR 0.16, p< 0.001) mortality and 90-day rehospitalization (18.5% Vs 34.2%, RR 0.54, p< 0.001) (Table 1). Patients who underwent early cholecystectomy were at a lower risk of acute cholangitis (RR 0.60, p< 0.001). The elderly subgroup had similar outcomes with improved 90-day mortality (1.3% Vs 4.9%, RR 0.26, p< 0.001) and 90-day rehospitalization (29% Vs 39%, RR 0.76, p< 0.001).

Discussion: Early cholecystectomy significantly reduces short-term mortality and hospital readmission in younger and older patients with acute biliary pancreatitis. Our findings emphasize the importance of performing cholecystectomy during the same hospitalization for acute biliary pancreatitis in all patients, including older adults.

Outcomes	Early Cholecystectomy	No early Cholecystectomy	Risk ratio (Risk difference)	P value	Odds ratio	95% confidence interval
30-day mortality	0.12% (10)	1.12% (92)	0.11 (-1%)	< 0.001	0.11	0.06-0.21
90-day mortality	0.33% (27)	2.1% (173)	0.16 (-1.77	< 0.001	0.15	0.10-0.23
30-day readmission	15.88% (1,302)	28.30% (2,320)	0.56 (-12.4%)	< 0.001	0.48	0.44-0.52
90-day readmission	18.5% (1,530)	34.24% (2,831)	0.54 (-15.7%)	< 0.001	0.44	0.41-0.47
Acute kidney injury	1.56% (128)	3.67% (301)	0.42 (-2.1%)	< 0.001	0.41	0.34-0.51
Necrotizing pancreatitis	0.75% (62)	1.66% (136)	0.45 (-0.8%)	< 0.001	0.45	0.33-0.61
Acute cholangitis^§	9.12% (748)	15.07% (1,236)	0.60 (-5.9%)	< 0.001	0.57	0.51-0.62
ERCP^†	4.06% (353)	7.83% (712)	0.52 (-3.7%)	< 0.001	0.50	(0.44-0.57)
Endoscopic sphincterotomy^¶	2.78% (230)	6.12% (506)	0.45 (-3.3%)	< 0.001	0.44	0.37-0.51
Biliary leak/perforation	0.13% (11)	0.12% (10)	1.10 (0.01%)	0.82	1.10	0.46-2.59

§ Within 90 days of acute pancreatitis, † all ERCP within a month of acute pancreatitis, ¶ within a week of acute pancreatitis. ERCP Endoscopic retrograde cholangiopancreatography.

Table: Table 1. Clinical Outcomes in Younger (< 70 years) Patients with Acute Biliary Pancreatitis.

Disclosures:

Ritu Singh indicated no relevant financial relationships.

Nikhil Kumta indicated no relevant financial relationships.

Ritu R. Singh, MD¹, Nikhil A. Kumta, MD, MS². D0018 - Early Cholecystectomy Improves Clinical Outcomes in Acute Biliary Pancreatitis Patients Across All Age Groups: A Multicenter Retrospective Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.