Optimal timing of cholecystectomy in children with gallstone pancreatitis

Badru, Faidah; Saxena, Saurabh; Breeden, Robert; Bourdillon, Maximillan; Fitzpatrick, Colleen; Chatoorgoon, Kaveer; Greenspon, José; Villalona, Gustavo A.

doi:10.1016/j.jss.2017.03.045

Cited by 11 publications

(3 citation statements)

References 23 publications

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“…This form of pancreatitis may be associated with higher rates of procedural intervention to remove gallstones or perform sphincterotomy (eg, endoscopic retrograde pancreatectomy, CCY) which, in our study, was independently associated with increased LOS but lower hospital revisits as the procedure treats the underlying pancreatitis cause. Indeed, CCY has been shown to lower readmission rates in adult patients in numerous studies (23,24), as well as a recent single center study focused on pediatric patients (25), and CCY during index hospitalization is endorsed by the American College of Gastroenterology (26). Additional causes of longer LOS in Hispanic patients may be due to delayed diagnosis, concerns about post-discharge follow-up, differences in clinical conditions (eg, pain control, feeding tolerance) or other unmeasured factors.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Length of Stay and 30‐Day Revisits in Pediatric Acute Pancreatitis

Barreto

Schrager

Russell

2018

J. pediatr. gastroenterol. nutr.

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Certain demographic and clinical factors, including gender, ethnicity, and type of CCC, were independently associated with LOS and risk of 30-day hospital revisit for pediatric AP. Children with malignant and gastrointestinal CCCs who require total parenteral nutrition are at highest risk for both longer LOS and hospital revisit when admitted with AP. These patient populations may benefit from intensive care coordination when hospitalized for AP.

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Section: Discussionmentioning

confidence: 99%

Factors Associated With Length of Stay and 30‐Day Revisits in Pediatric Acute Pancreatitis

Barreto

Schrager

Russell

2018

J. pediatr. gastroenterol. nutr.

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“…This study also found higher readmission rates in the delayed group compared to the early cholecystectomy group (40% vs 5%, p = 0.0001), with higher recurrence rates (28% vs 2%, p = 0.0001). A similar study on pediatric gallstone pancreatitis showed similar readmission rates of 31% in those without early cholecystectomy [ 18 ]. Our study showed similar differences in readmission rates in the pediatric patients who underwent conservative vs early cholecystectomy specifically for acute cholecystitis (22.6% vs 2.8%, p < 0.001).…”

Section: Discussionmentioning

confidence: 89%

Index admission cholecystectomy for acute cholecystitis reduces 30-day readmission rates in pediatric patients

Pathak,

Ji,

Nijagal

et al. 2023

Surg Endosc

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Background Adult patients with cholecystitis who do not undergo cholecystectomy on index admission have worse outcomes, however, there is a paucity of data of the role of cholecystectomy during index hospitalization in the pediatric population. Our aim was to determine outcomes and readmission rates among pediatric patients with cholecystitis who underwent index cholecystectomy versus those who did not. Methods We performed a retrospective study of pediatric (< 18 years old) admitted with acute cholecystitis (AC) requiring hospitalization using the 2018 National Readmission Database (NRD). Exclusion criteria included age ≥ 18 years and death on index admission. Multivariable logistic regression was performed to identify factors associated with 30-day readmissions. Results We identified 550 unique index acute cholecystitis admissions. Mean age was 14.6 ± 3.0 years. Majority of patients were female (n = 372, 67.6%). Index cholecystectomy was performed in (n = 435, 79.1%) of cases. Thirty-day readmission rate was 2.8% in patients who underwent index cholecystectomy and 22.6% in those who did not (p < 0.001). On multivariable analysis, patients who did not undergo index cholecystectomy had higher odds of 30-day readmission than those who did not (OR 10.66, 95% CI 5.06–22.45, p < 0.001). Female patients also had higher odds of 30-day readmission compared to males (OR 3.37, 95% CI 1.31–8.69). Conclusions Patients who did not undergo index cholecystectomy had over tenfold increase in odds of 30-day readmission. Further research is required to understand the barriers to index cholecystectomy despite society recommendations and clear clinical benefit.

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“…In these children, the rationale for cholecystectomy during the index admission is to avoid the potential complications of delayed surgery, such as recurrent episodes of acute cholecystitis, pancreatitis, and cholangitis, which may require emergency surgery, longer hospital stays, and increased healthcare costs. This approach has been recommended in recent guidelines from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN), but based on very limited data from smaller cohorts; this study provides data from a national cohort to support the recommendation [ 10 – 13 , 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Index admission cholecystectomy for biliary acute pancreatitis or choledocholithiasis reduces 30-day readmission rates in children

Pathak,

Avila,

Dai

et al. 2024

Surg Endosc

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Background Adult patients with biliary acute pancreatitis (BAP) or choledocholithiasis who do not undergo cholecystectomy on index admission have worse outcomes. Given the paucity of data on the impact of cholecystectomy during index hospitalization in children, we examined readmission rates among pediatric patients with BAP or choledocholithiasis who underwent index cholecystectomy versus those who did not. Methods Retrospective study of children (< 18 years old) admitted with BAP, without infection or necrosis (ICD-10 K85.10), or choledocholithiasis (K80.3x–K80.7x) using the 2018 National Readmission Database (NRD). Exclusion criteria were necrotizing pancreatitis with or without infected necrosis and death during index admission. Multivariable logistic regression was performed to identify factors associated with 30-day readmission. Results In 2018, 1122 children were admitted for index BAP (n = 377, 33.6%) or choledocholithiasis (n = 745, 66.4%). Mean age at admission was 13 (SD 4.2) years; most patients were female (n = 792, 70.6%). Index cholecystectomy was performed in 663 (59.1%) of cases. Thirty-day readmission rate was 10.9% in patients who underwent cholecystectomy during that index admission and 48.8% in those who did not (p < 0.001). In multivariable analysis, patients who underwent index cholecystectomy had lower odds of 30-day readmission than those who did not (OR 0.16, 95% CI 0.11–0.24, p < 0.001). Conclusions Index cholecystectomy was performed in only 59% of pediatric patients admitted with BAP or choledocholithiasis but was associated with 84% decreased odds of readmission within 30 days. Current guidelines should be updated to reflect these findings, and future studies should evaluate barriers to index cholecystectomy.

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Optimal timing of cholecystectomy in children with gallstone pancreatitis

Cited by 11 publications

References 23 publications

Factors Associated With Length of Stay and 30‐Day Revisits in Pediatric Acute Pancreatitis

Factors Associated With Length of Stay and 30‐Day Revisits in Pediatric Acute Pancreatitis

Index admission cholecystectomy for acute cholecystitis reduces 30-day readmission rates in pediatric patients

Index admission cholecystectomy for biliary acute pancreatitis or choledocholithiasis reduces 30-day readmission rates in children

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