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. 2025 May 10:26:79-86.
doi: 10.1016/j.sopen.2025.05.002. eCollection 2025 Jun.

National trends in utilization and readmission following intraoperative cholangiography in gallstone pancreatitis

Ayesha P Ng  1 , Troy N Coaston  1 , Konmal Ali  1 , Christian de Virgilio  2 , Peyman Benharash  1
Affiliations

National trends in utilization and readmission following intraoperative cholangiography in gallstone pancreatitis

Ayesha P Ng et al. Surg Open Sci. .

Abstract

Background: In the absence of cholangitis, the role of intraoperative cholangiography (IOC) to exclude retained stones in mild gallstone pancreatitis (GSP) remains controversial. Using a nationally representative database, we examined the contemporary utilization of IOC and index outcomes and readmission following cholecystectomy for GSP.

Methods: All adults undergoing nonelective cholecystectomy for mild GSP in the 2017-2021 Nationwide Readmissions Database were identified. Patients were stratified based on the use of IOC. Multivariable regressions and Royston-Parmar analysis were used to evaluate the association of IOC use with outcomes of interest.

Results: Of 152,687 patients, 24.7 % underwent IOC. Utilization of IOC significantly decreased from 26.5 % to 20.7 % over the study period (p < 0.001). Compared to patients without IOC, IOC patients were older and more commonly treated at high-volume, private hospitals. Following risk adjustment, the odds of major adverse events, including mortality, complications, and bile duct injury repair were comparable between cohorts. Furthermore, length of stay and hospitalization costs were comparable between patients with and without IOC. Notably, IOC was significantly associated with 20 % decreased odds of 90-day readmission for recurrent pancreatitis or retained stone, which persisted over time (AOR 0.80 [95 % CI 0.74-0.86]).

Conclusions: IOC was associated with significantly reduced readmission and comparable resource use following cholecystectomy for GSP. Despite its decreasing utilization, IOC may be a cost-effective strategy to help reduce risk for recurrent biliary disease among patients with mild GSP.

Keywords: Bile duct; Cholecystectomy; Gallstone pancreatitis; Intraoperative cholangiography; Outcomes; Readmission.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Unlabelled Image
Graphical abstract
Fig. 1
Fig. 1
Temporal trend in utilization rate of intraoperative cholangiography during cholecystectomy for mild gallstone pancreatitis.
Fig. 2
Fig. 2
Risk-adjusted outcomes associated with use of intraoperative cholangiography (IOC) during cholecystectomy for mild gallstone pancreatitis. MAE: Major adverse events are a composite of mortality, any complications, and repair of bile duct injury (BDI). CBD: Common bile duct. ERCP: Endoscopic Retrograde Cholangiopancreatography.
Fig. 3
Fig. 3
Indications for readmission within 90 days of discharge following cholecystectomy for mild gallstone pancreatitis, stratified by the use of intraoperative cholangiography (IOC). GI: Gastrointestinal.
Fig. 4
Fig. 4
Royston-Parmar time- and risk-adjusted hazard analysis for 90-day nonelective readmission following cholecystectomy for mild gallstone pancreatitis, stratified by use of intraoperative cholangiography (IOC).
Fig. 5
Fig. 5
Temporal trend in risk-adjusted rate of 90-day readmission following cholecystectomy for mild gallstone pancreatitis, stratified by use of intraoperative cholangiography (IOC).
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