Key points Is it safe to perform early cholecystectomy in patients with moderate and severe acute biliary pancreatitis (ABP)? Findings This cohort study of 3,696 patients hospitalized for acute biliary pancreatitis (ABP) found that early cholecystectomy in those with moderately severe and severe ABP had a higher risk of mortality and morbidity compared with patients with mild acute biliary pancreatitis undergoing early cholecystectomy. and with patients with moderately severe and severe PBA undergoing late cholecystectomy. Meaning This study suggests that older and frailer patients with moderately severe and severe acute biliary pancreatitis (ABP) complications should not be considered for early cholecystectomy . |
Importance
Considering the lack of balance regarding the timing of cholecystectomy in patients with moderate and severe acute biliary pancreatitis (ABP), it is essential to evaluate this issue.
Aim
To evaluate the results of early cholecystectomy (EC) in patients with moderate and severe PBA.
Design, environments and participants
This cohort study retrospectively analyzed real-life data from the MANCTRA-1 (Adherence to Evidence-Based Clinical Guidelines in the Management of Acute Biliary Pancreatitis) dataset, evaluating 5,304 consecutive patients hospitalized between January 1, 2019. .and December 31, 2020, for ABP from 42 countries.
A total of 3,696 patients who were hospitalized for PBA and underwent early cholecystectomy (EC) were included in the analysis; of these, 1,202 underwent CE, defined as a cholecystectomy performed within 14 days of admission.
Univariable and multivariable logistic regression models were used to identify predictors of mortality and morbidity. Data analysis was carried out from January to February 2023.
Main results
Mortality and morbidity after cholecystectomy (CE).
Results
Of the 3,696 patients (mean [SD] age, 58.5 [17.8] years; 1,907 [51.5%] women) included in the analysis, 1,202 (32.5%) underwent CE and 2,494 (67 .5%) underwent delayed cholecystectomy (DC).
Overall, CE had a higher risk of postoperative mortality (1.4% vs 0.1%, p<<0.001) and morbidity (7.7% vs 3.7%, p<<0.001) compared with delayed cholecystectomy (DC).
In multivariate analysis, moderately severe and severe PBA were associated with increased mortality (odds ratio [OR], 361.46; 95% CI, 2.28-57,212.31; p= 0.02). and morbidity (OR, 2.64; 95% CI, 1.35-5.19; p = .005).
In patients with moderate and severe PBA (n = 108), CE was associated with a higher risk of mortality (16 [15.6%] vs 0 [0%], P< 0.001), morbidity (30 [30, 3%] vs 57 [5.5%], P < 0.001), bile leak (2 [2.4%] vs 4 [0.4%], P = 0.02), and infections (12 [ 14.6%] vs 4 [0.4%], P < .001) compared with patients with mild PBA who underwent CE.
In the multivariable analysis, patient age (OR, 1.12; 95% CI, 1.02-1.36; P = .03) and American Society of Anesthesiologists score (OR, 5 .91; 95% CI, 1.06-32.78; P = .04) were associated with mortality; serious complications of PBA were associated with increased mortality (OR, 50.04; 95% CI, 2.37-1058.01; P = 0.01) and morbidity (OR, 33.64; 95%, 3.19-354.73; P = 0.003).
Conclusions and relevance The findings of this cohort study suggest that CE should be carefully considered in patients with moderate and severe PBA, as it was associated with increased postoperative mortality and morbidity. However, older and frailer patients who manifest severe PBA-related complications should probably not be considered for early cholecystectomy (EC). |
