Prompt cholecystectomy might curb hospital stay

Last Updated: 2018-08-23

By Reuters Staff

NEW YORK (Reuters Health) - Cholecystectomy within 48 hours of admission for mild gallstone pancreatitis is associated with reduced hospital stay without an increase in complications, according to a retrospective study.

Gallstones are the most common cause of acute pancreatitis, but the timing of cholecystectomy is controversial, Dr. Ashkan Moazzez and colleagues at Harbor-UCLA Medical Center, in Torrance, California, note in JAMA Surgery, online August 15.

Recent research has shown that early cholecystectomy may limit length of hospital stay under such circumstances, but many institutions delay the procedure until normalization of laboratory values and resolution of abdominal pain.

To investigate further, the researchers examined national data and identified more than 1,900 patients with acute pancreatitis who, between 2011 and 2014, underwent same-admission cholecystectomy. Of these, 42.5% underwent laparoscopic cholecystectomy within 48 hours of being hospitalized.

There was no significant difference between late and early groups in terms of mortality. But bivariate analyses showed that the early group had significantly more laparoscopically completed procedures (odds ratio, 1.56) and concurrent biliary interventions (OR, 1.69) as well as significantly fewer reoperations (OR, 0.37).

Moreover, multivariable analysis showed that the early procedure was independently associated with a reduction in hospital stay of 3.44 days (P<0.001) and an operative-time reduction of 8.44 minutes (P<0.001).

Thirty-day hospital readmissions did not differ between groups.

The authors concede that limited data were available and that they were unable to calculate a Ranson score. Thus, they say, "severe pancreatitis was inferred based on evidence of organ dysfunction."

But given their findings they conclude that an early procedure "may be the preferred approach, with the understanding that" it may be "associated with more concurrent intraoperative biliary interventions."

Dr. Moazzez did not respond to requests for comments.

SOURCE: https://bit.ly/2OZI0DS

JAMA Surg 2018.