Timing of Cholecystectomy After Moderate and Severe Acute Biliary Pancreatitis
Authors: Di Martino Marcello , Ielpo Benedetto , Pata Francesco , Pellino Gianluca , Di Saverio Salomone , Catena Fausto , De Simone Belinda , Coccolini Federico , Sartelli Massimo , Damaskos Dimitrios , Mole Damian , Murzi Valentina , Leppaniemi Ari , Pisanu Adolfo , Podda Mauro ,   MANCTRA-1 Collaborative Group, Gerardi Chiara , Virdis Francesco , Pacella Daniela , Jayant Kumar , Agresta Ferdinando , Riboni Cristiana , Kluger Yoram , de Santibañes Martin , Di Menno Stavron Juliana , Mazza Oscar , Valenzuela José I , Pachajoa Diana AP , Alvarez Fernando A , Liaño Julian E , Gundara Justin , Tefay Joan , Alawadhi Kamel , Alshaikh Abdulrahman , Hasan Layla , Gomes Carlos A , Gomes Felipe C , Fraga Gustavo P , Calderan Thiago RA , Hirano Elcio S , Dardanov Dragomir , Julianov Alexander , Saroglu Azize , Atanasov Boyko , Belev Nikolay , Kovachev Nikola , Lui Rashid , Chan Shannon M , Lok Hon-Ting , Salcedo Diego , Robayo Diana , Triviño Maria A , Manak Jan , Sahani Saaz , de Araujo Jorann , Sethi Ananya , Awad Ahmed , Elbadawy Merihan , Farid Ahmed , Hanafy Asmaa , Nafea Ahmed , Ghozy Sherief , Salah–Abbas Alzhraa , Abdelsalam Wafaa , Emile Sameh , Elfallal Ahmed , Elfeki Hossam , Elghadban Hosam , Shoma Ashraf , Shetiwy Mohamed , Elbahnasawy Mohamed , Mohamed Salem , Hamed Emad F , Khalil Usama A , Chouillard Elie , Gumbs Andrew , Police Andréa , Mabilia Andrea , Demetrashvili Zaza , Khutsishvili Kakhi , Tvaladze Anano , Ioannidis Orestis , Anestiadou Elissavet , Loutzidou Lydia , Ioannidis Argyrios , Konstantinidis Konstantinis , Konstantinidou Sofia , Manatakis Dimitrios , Acheimastos Vasileios , Tasis Nikolaos , Michalopoulos Nikolaos , Kokoropoulos Panagiotis , Papadoliopoulou Maria , Sotiropoulou Maria , Kapiris Stylianos , Metaxas Panagiotis , Tsouknidas Ioannis , Kefili Despoina , Petrakis George , Synekidou Eirini , Dakis Konstantinos , Alexandridou Eirini , Papadopoulos Aristeidis , Chouliaras Christos , Mouzakis Odysseas , Mulita Francesk , Maroulis Ioannis , Vailas Michail , Triantafyllou Tania , Theodorou Dimitrios , Lostoridis Eftychios , Nagorni Eleni A , Tourountzi Paraskevi , Baili Efstratia , Charalabopoulos Alexandros , Liakakos Theodore , Schizas Dimitrios , Kozadinos Alexandros , Syllaios Athanasios , Machairas Nikolaos , Kykalos Stylianos , Stamopoulos Paraskevas , Delis Spiros , Farazi-Chongouki Christos , Kalaitzakis Evangelos , Giannarakis Miltiadis , Lasithiotakis Konstantinos , Petra Giorgia , Ralon Sergio , Gupta Amit , Medappil Noushif , Muthukrishnan Vijayanand , Kamar Jubin , Bains Lovenish , Lal Pawan , Agarwal Rajendra , Magnoli Matteo , Aonzo Paolo , Serventi Alberto , Giuliani Antonio , Di Lascio Pierpaolo , Pinto Margherita , Bergamini Carlo , Bottari Andrea , Fortuna Laura , Martellucci Jacopo , Cicako Atea , Miglietta Claudio , Morino Mario , Delogu Daniele , Picchetto Andrea , Assenza Marco , D'Ambrosio Giancarlo , Argenio Giulio , Ioia Giovanna , Armellino Mariano F , Occhionorelli Savino , Lacavalla Domenico , Andreotti Dario , Luppi Davide , Casadei Massimiliano , Di Donato Luca , Manoochehri Farshad , Marchese Tiziana RL , Sergi William , Manca Roberto , Murgia Raimondo , Piras Enrico , Conti Lorenzo , Gianazza Simone , Rizzi Andrea , Segalini Edoardo , Monti Marco , Liritano Elena , Mariani Nicolò M , De Nicola Enrico , Scifo Giovanna , Pignata Giusto , Andreuccetti Jacopo , Fleres Francesco , Clarizia Guglielmo , Spolini Alessandro , Biloslavo Alan , Germani Paola , Mastronardi Manuela , Bogoni Selene , Palmisano Silvia , De Manzini Nicolò , Marino Marco V , Poillucci Gaetano , Martines Gennaro , Trigiante Giuseppe , Lagouvardou Elpiniki , Anania Gabriele , Bombardini Cristina , Oppici Dario , Pilia Tiziana , Murzi Valentina , Gessa Emanuela , Locci Eleonora , Bracale Umberto , Di Nuzzo Maria M , Peltrini Roberto , Ansaloni Luca , Salvetti Francesco , Viganò Jacopo , Sganga Gabriele , Bianchi Valentina , Fransvea Pietro , Fontana Tommaso , Sarro Giuliano , Dinuzzi Vincenza P , Scaravilli Luca , Papa Mario V , Jovine Elio , Ciabatti Giulia , Mastrangelo Laura , Rottoli Matteo , Ricci Claudio , Russo Iris S , Aiolfi Alberto , Bona Davide , Lombardo Francesca , Cianci Pasquale , Sederino Mariagrazia , Bini Roberto , Chiara Osvaldo , Cioffi Stefano PB , Giordano Alessio , Cantafio Stefano , Coretti Guido , Licitra Edelweiss , Savino Grazia , Grimaldi Sergio , Porfidia Raffaele , Moggia Elisabetta , Garino Mauro , Marafante Chiara , Pesce Antonio , Fabbri Nicolò , Feo Carlo V , Marra Ester , Nagliati Carlo , Troian Marina , Drigo Davide , Muratore Andrea , Danna Riccardo , Murgese Alessandra , Crespi Michele , Ferrario Luca , Guerci Claudio , Frontali Alice , Ferrari Luca , Favi Francesco , Picariello Erika , Rampini Alessia , D'Acapito Fabrizio , Ercolani Giorgio , Solaini Leonardo , Palmieri Francesco , Calì Matteo , Ferrara Francesco , Muttillo Irnerio A , Muttillo Edoardo M , Picardi Biagio , Galleano Raffaele , Badran Ali , Ghazouani Omar , Cervellera Maurizio , Campanella Gaetano , Papa Gennaro , Di Bella Annamaria , Perrone Gennaro , Petracca Gabriele L , Prioriello Concetta , Giuffrida Mario , Cozzani Federico , Rossini Matteo , Inama Marco , Butturini Giovanni , Moretto Gianluigi , Morelli Luca , Di Candio Giulio , Guadagni Simone , Cicuttin Enrico , Cremonini Camilla , Tartaglia Dario , Genovese Valerio , Chiarugi Massimo , Cillara Nicola , Cannavera Alessandro , Deserra Antonello , Picciariello Arcangelo , Papagni Vincenzo , Vincenti Leonardo , Bagaglini Giulia , Sica Giuseppe , Lapolla Pierfrancesco , Brachini Gioia , Mingoli Andrea , Bono Dario , Nicotera Antonella , Zago Marcello , Sammartano Fabrizio , Benuzzi Laura , Stella Marco , Rossi Stefano , Cerioli Alessandra , Puccioni Caterina , Olmi Stefano , Rubicondo Carolina , Uccelli Matteo , Balla Andrea , Guida Anna , Lepiane Pasquale , Sasia Diego , Giraudo Giorgio , Salomone Sara , Nigri Giuseppe , Belloni Elena , Cossa Alessandra , Lancellotti Francesco , Caronna Roberto , Chirletti Piero , Saullo Paolina , Troiano Raffaele , Mucilli Felice , Barone Mirko , Ippoliti Massimo , Grande Michele , Sensi Bruno , Siragusa Leandro , Ortenzi Monica , Santini Andrea , Veroux Gastone , Di Carlo Isidoro , Gioco Rossella , Veroux Massimiliano , Currò Giuseppe , Ammendola Michele , Komaei Iman , Navarra Giuseppe , Tonini Valeria , Sartarelli Lodovico , Vaccari Samuele , Ceresoli Marco , Perrone Stefano , Roccamatisi Linda , Millo Paolo , Brachet-Contul Riccardo , Ponte Elisa , Zuin Matteo , Portale Giuseppe , Tonello Alice S , Fratini Geri , Bianchini Matteo , Perotti Bruno , Doria Emanuele , Lunghi Elia G , Visconti Diego , Khamees Almu'atasim , Al-Shami Khayry , Awadi Sajeda , Ababneh Hazim , Buwaitel Mohammad MK , Naffa' Mo'taz FN , Aljaiuossi Osama , Samhouri Ahmad , Sawalha Hatem , Yusoff Ahmad R , Che Ani Mohd F , Fathil Ida NA , Huei Jih , Mohamad Ikhwan S , Zakaria Andee D , Ya'acob Mohammad Z , Beristain-Hernandez Jose L , Garcia-Meza Alejandro , Sepulveda-Rodriguez Rafael , Lozada Hernández Edgard E , Acuña Pinzón Camilo L , Condoy Jefferson N , Becerra García Francisco C , Pimentel Samuel , Garzali Ibrahim U , Sadik Mohammad , Kadir Bushra , Devi Jalpa , Seerani Nandlal , Sohail- Asghar Mohammad , Afzal Ameer , Akbar Ali , Machain Gustavo M , Segovia Lohse Helmut , Segovia Lohse Herald , Quispe-Cruz Darwin A , Cabrera Zamiara SL , Yamamoto Seto Gaby S , Chiuyari José R , Ordemar Jorge , Rodríguez Martha , Orantia-Carlos Abigail CC , Quitoy Margie A , Walędziak Maciej , Kwiatkowski Andrzej , Mawlichanów Maciej , Correia de Sá Tiago , Rocha Mónica , Soares Carlos , Muhammad Ali Syed , Stoian Alexandru R , Draghici Andreea D , Grigorean Valentin T , Calu Valentin , Radulescu Raluca B , Zarnescu Narcis O , Costea Radu V , Zarnescu Eugenia C , Litvin Andrey , Kurtenkov Mikhail , Gendrikson George , Alla-Angelina Volovich , Tsurbanova Arina , Kaldarov Ayrat , Gachabayov Mahir , Abdullaev Abakar , Kovacevic Bojan , Milentijevic Milica , Karamarkovic Milovan , Panyko Arpád , Lesko Dusan , Radonak Jozef , Soltes Marek , Noel Colin , Abdalah Haidar M , Hamid Hytham KS , Roesel Raffaello , Cristaudi Alessandra , Hamdan Alaa , Abbas Kinan , Ali Iyad , Kchaou Ali , Tlili Ahmed , Isik Arda , Bayhan Hüseyin , Türkoğlu Mehmet A , Uzunoglu Mustafa Y , Azamat Ibrahim F , Omarov Nail , Uymaz Derya S , Altintoprak Fatih , Akin Emrah , First Necattin , Das Koray , Ozer Nazmi , Seker Ahmet , Kara Yasin , Bozkurt Mehmet A , Kocataş Ali , Atici Semra D , Akalin Murat , Calik Bulent , Colak Elif , Altinel Yuksel , Meric Serhat , Aktimur Yunus E , Chooklin Serge , Chuklin Serhii , Bilyak Andriy , Bonilla Cal Fernando , Sánchez Lianet , Domínguez Fabiana , Meead Abdullah , Al-Raimi Ibrahim , Alshargabi Haneen , Hudson Victoria , Duval Jean-Luc , Gourgiotis Stavros , Khan Mansoor , Saad Ahmed , Kaur Mandeep , Wilson Michael , Bradley Alison , Fox Katherine , Tomasi Ivan , Beasley Daniel , Prasanti Alekhya K , Kotecha Pinky , Ebied Husam , Soggiu Fiammetta , Paul Michaela , Sheth Hemant , Gerogiannis Ioannis , Gaber Mohannad , Sheikh Zara , Seth Shatadru , Kunitsyna Maria , Leo Cosimo A , Bellato Vittoria , Zafar Noman , Elserafy Amr , Bond-Smith Giles , Tebala Giovanni , Mathur Pawan , Abid Izza , Chidumije Nnaemeka , Sandhar Pardip , Ullah Syed OZ , Lezama Tamara , Anwaar Muhammad H , Magee Conor , Ahmed Salma , Davies Brooke , Apollos Jeyakumar , McCormack Kieran , Choudhary Hasham , Doulias Triantafyllos , Morrison Tamsin , Palepa Anna , Álvarez Morán Laura , Calvo García Haydée , Suárez Vega Pilar , Estevez Sergio , Prieto Calvo Mikel , Villalabeitia Ibabe , Ausania Fabio , Farguell Jordi , González-Abós Carolina , Sánchez-Cabús Santiago , Martín Belén , Molina Víctor , Oms Luis , Ilzarbe Lucas , Pont Feijóo Eva , Perra Elena S , Rojas-Bonet Noel , Penalba-Palmí Rafael , Pérez-Bru Susana , Tur-Martínez Jaume , Álvarez-Torrado Andrea , Domingo-Gonzalez Marta , Tejedor-Tejada Javier , García del Alamo Yaiza , Mendoza-Moreno Fernando , García-Moreno-Nisa Francisca , Matías-García Belén , Durán Manuel , Calleja-Lozano Rafael , Perez de Villar José M , Sánchez-Guillén Luis , Caravaca Iban , Triguero-Cánovas Daniel , Maya Aparicio Antonio C , Durán Meléndez Blas , Masiá Palacios Andrea , Landaluce-Olavarria Aitor , De Francisco Mario , Estraviz-Mateos Begoña , Alconchel Felipe , Nicolás-López Tatiana , Ramírez Pablo , Muñoz-Cruzado Virginia D , Pareja Ciuró Felipe , Perea del Pozo Eduardo , Olivares Pizarro Sergio , Herrera Cabrera Vicente , Muros Bayo Jose 
Published: August 2023

Importance

Considering the lack of equipoise regarding the timing of cholecystectomy in patients with moderately severe and severe acute biliary pancreatitis (ABP), it is critical to assess this issue.

Objective

To assess the outcomes of early cholecystectomy (EC) in patients with moderately severe and severe ABP.

Design, Settings, and Participants

This cohort study retrospectively analyzed real-life data from the MANCTRA-1 (Compliance With Evidence-Based Clinical Guidelines in the Management of Acute Biliary Pancreatitis) data set, assessing 5304 consecutive patients hospitalized between January 1, 2019, and December 31, 2020, for ABP from 42 countries. A total of 3696 patients who were hospitalized for ABP and underwent cholecystectomy were included in the analysis; of these, 1202 underwent EC, defined as a cholecystectomy performed within 14 days of admission. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality and morbidity. Data analysis was performed from January to February 2023.

Main Outcomes

Mortality and morbidity after EC.

Results

Of the 3696 patients (mean [SD] age, 58.5 [17.8] years; 1907 [51.5%] female) included in the analysis, 1202 (32.5%) underwent EC and 2494 (67.5%) underwent delayed cholecystectomy (DC). Overall, EC presented an increased risk of postoperative mortality (1.4% vs 0.1%, P &amp;lt; .001) and morbidity (7.7% vs 3.7%, P &amp;lt; .001) compared with DC. On the multivariable analysis, moderately severe and severe ABP were associated with increased mortality (odds ratio [OR], 361.46; 95% CI, 2.28-57 212.31; P = .02) and morbidity (OR, 2.64; 95% CI, 1.35-5.19; P = .005). In patients with moderately severe and severe ABP (n = 108), EC was associated with an increased risk of mortality (16 [15.5%] vs 0 [0%], P &amp;lt; .001), morbidity (30 [30.3%] vs 57 [5.5%], P &amp;lt; .001), bile leakage (2 [2.4%] vs 4 [0.4%], P = .02), and infections (12 [14.6%] vs 4 [0.4%], P &amp;lt; .001) compared with patients with mild ABP who underwent EC. In patients with moderately severe and severe ABP (n = 108), EC was associated with higher mortality (16 [15.5%] vs 2 [1.2%], P &amp;lt; .001), morbidity (30 [30.3%] vs 17 [10.3%], P &amp;lt; .001), and infections (12 [14.6%] vs 2 [1.3%], P &amp;lt; .001) compared with patients with moderately severe and severe ABP who underwent DC. On the multivariable analysis, the patient’s 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; severe complications of ABP were associated with increased mortality (OR, 50.04; 95% CI, 2.37-1058.01; P = .01) and morbidity (OR, 33.64; 95% CI, 3.19-354.73; P = .003).

Conclusions and Relevance

This cohort study’s findings suggest that EC should be considered carefully in patients with moderately severe and severe ABP, as it was associated with increased postoperative mortality and morbidity. However, older and more fragile patients manifesting severe complications related to ABP should most likely not be considered for EC.