National analysis of outcomes in timing of cholecystectomy for acute cholangitis

Abstract

Background

The present study aimed to compare outcomes between cholecystectomy on index versus delayed admission for acute cholangitis.

Methods

The 2011–2020 Nationwide Readmissions Database was used to identify adult patients admitted for acute cholangitis who underwent cholecystectomy. Study cohorts were defined based on timing of surgery. Multivariable regressions and Royston-Parmar time-adjusted analysis were used to evaluate the association of cholecystectomy timing and outcomes.

Results

Of 65,753 patients, 82.0 ​% received surgery on Index and 18.0 ​% on Delayed admissions. Following adjustment, Delayed operation was associated with significantly increased odds of mortality (AOR 1.67 [95 ​% CI 1.10–2.54]), complications (1.25 [1.13–1.40]), repair of bile duct injury (1.66 [1.15–2.41]), conversion to open (1.69 [1.48–1.93]), and 30-day readmission (3.52 [3.21–3.86]). The Delayed cohort experienced a +$14,200 increment in hospitalization costs relative to Index.

Conclusions

Delayed cholecystectomy for acute cholangitis is significantly associated with adverse postoperative outcomes, suggesting that index cholecystectomy may be safe to perform.