Cholecystectomy decreases readmission, mortality rates in acute cholangitis
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Laparoscopic cholecystectomy in addition to endoscopic retrograde cholangiopancreatography in patients with acute cholangitis correlated with a decrease in 30-day and 90-day readmission and 30-day mortality, according to study results.
“Our study revealed that performing [laparoscopic cholecystectomy (LC)] on index admission following complete endoscopic clearance of bile duct in patients with acute gallstone cholangitis significantly decreased the 30-day readmission rate by 40.43% (absolute reduction rate),” Gilles Jadd Hoilat, MD, from the department of internal medicine, State University of New York Upstate Medical University, in New York, and colleagues wrote. “Furthermore, the odds of 30-day readmission rate was 90% less in the group of patients that underwent LC on the same admission.”
Hoilat and colleagues conducted a retrospective study of 114 patients with acute cholangitis who underwent endoscopic retrograde cholangiopancreatography (ERCP) with complete clearance of the bile duct as an index procedure. Patients were divided into two groups: those who underwent only ERCP, and those who underwent ERCP with laparoscopic cholecystectomy on same admission. The 30-day readmission rate served as the primary endpoint.
Results showed lower rates of readmission in the ECRP plus laparoscopic cholecystectomy group compared with the ECRP group (2.2% vs 42.6%, P < .001). In addition, the ECRP plus laparoscopic cholecystectomy group had lower rates in 90-day readmission (2.2% vs. 30.9%, P < .001) and 30-day mortality (2.2% vs. 16.2%, P = .017).
According to results from multivariate logistic regression analysis, patients in the ECRP plus laparoscopic cholecystectomy group compared with those who did not undergo laparoscopic cholecystectomy at admission had 90% lower odds of 30-day readmission (OR = 0.1; 95% CI, 0.032-0.313).
“Based on the evidence shown, early cholecystectomy in patients with [acute cholangitis] following ERCP during the same admission was associated with a lower 30-day and 90-day readmission rate as well as a reduced recurrence of biliary symptoms without any increase in intraoperative, postoperative complications and length of hospital stay,” the authors wrote. “Therefore, early cholecystectomy should be recommended following complete endoscopic clearance of the common bile duct. Randomized clinical trials with a bigger sample size should be conducted to confirm the benefits of cholecystectomy during admission.”
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