Determinants and outcomes of early cholecystectomy for mild gallstone pancreatitis in British Columbia, Canada

Abstract Background Early cholecystectomy is recommended for patients with gallstone pancreatitis to reduce recurrent gallstone-related adverse events. However, the management of patients with gallstone pancreatitis in British Columbia (BC) is not known. This study aims to determine the prevalence of early cholecystectomy and outcomes among patients admitted in BC with mild gallstone pancreatitis. Methods A retrospective multicentre cohort of patients with gallstone pancreatitis admitted from 2018 to 2023 to 4 BC hospitals. Exclusion criteria included prior cholecystectomy, pancreatic cancer, and patients with moderate or severe pancreatitis. Patients receiving a cholecystectomy in ≤30 days were labelled early and compared to late cholecystectomy (>30 days) or no cholecystectomy. The primary outcome was recurrent biliary events, including cholecystitis, choledocholithiasis, and pancreatitis. Results In total, 260 patients were included in the analysis and 35.0% had early cholecystectomy. Early cholecystectomy was associated with younger age (53.0 years vs 65.4 years, P < .001) and fewer comorbidities (Charlson Comorbidity Index 1.6 vs 3.3, P < .001) in univariate analysis. Multivariate analysis identified nonsurgical admission to gastroenterology (OR, 0.16; 95% CI, 0.06-0.44; P < .001) or other services (OR, 0.07; 95% CI, 0.028-0.17; P < .001) as less likely to result in early cholecystectomy. Patients who received late cholecystectomy were more likely to experience recurrent biliary events in univariate (HR, 3.16; 95% CI, 1.93-5.20; P < .001) and multivariate Cox-regression analysis (HR, 4.36; 95% CI, 1.9-10.1). Conclusions Early cholecystectomy reduces recurrent biliary events. Admission under surgery is associated with early cholecystectomy and may be important in achieving higher rates of index admission cholecystectomy.