By Ethan Covey

Adherence to best practices for cholecystectomy in patients with gallstone pancreatitis is low and has not changed significantly since the late 1990s, despite strong clinical evidence and multiple practice guidelines. Additionally, gaps in care exist across the United States, highlighting the need for improved implementation efforts.

“Numerous national and international guidelines recommend cholecystectomy during the index admission,” said James C. Etheridge, MD, a general surgery resident at Brigham and Women’s Hospital, in Boston. “A growing body of evidence shows the operation can be safely performed within 48 hours of admission, regardless of symptomatic or biochemical improvement. This reduces length of stay with no discernible effect on mortality, perioperative complications or technical difficulty.”

The study used data from the National Inpatient Sample to identify patients admitted to hospital for gallstone pancreatitis from 2015 to 2018.

From a total of 163,390 annual admissions for gallstone pancreatitis, 56% underwent same-admission cholecystectomy. This group of patients was generally younger, female, had fewer comorbidities and less severe disease, and the procedure was more common in urban hospitals, teaching centers and the southern part of the country.

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Only 27% of patients underwent cholecystectomy within 48 hours of admission.

“This finding is unsurprising,” Dr. Etheridge said. “Nonetheless, it does indicate that there is room to improve the timelines, efficiency and cost-effectiveness of surgical care for gallstone pancreatitis.

“To maximize the public health value of evidence-based practices for gallstone pancreatitis, active implementation efforts are necessary,” Dr. Etheridge added. “In addition, the fact that patients in small and rural hospitals were less likely to receive same-admission cholecystectomy may indicate that limited surgical capacity is a barrier. Future efforts should identify specific approaches to overcome barriers and leverage facilitators for timely surgery.”

This article is from the January 2022 print issue.