Samantha R Witte, MD, Katelin Mirkin, MD, Jerome Lyn-Sue, MD. Penn State Health
Introduction: The management of acute complicated cholecystitis with choledocholithiasis diagnosed either during the initial workup or in the operating room by cholangiogram can be a complex and challenging problem to manage. We compared outcomes between patients who underwent preoperative ERCP followed by delayed cholecystectomy during the same hospital admission with patients who underwent a combined procedure with intraoperative ERCP. We hypothesize that on-table ERCP will decrease length of stay and associated hospital cost, without increasing the rate of procedural complication.
Methods and Procedures: We retrospectively reviewed the 2017-2018 database of an academic hospital for patients with acute complicated cholecystitis or choledocholithiasis who underwent laparoscopic cholecystectomy and ERCP. The study population was then divided into two cohorts: those who underwent preoperative ERCP followed by laparoscopic cholecystectomy, and those who underwent combined interventions. Primary outcomes evaluated were hospital length of stay, discharge destination, and days remaining in hospital after operation.
Results: A total of 29 patients were included in this study. One patient was excluded for oncologic pathology, and one patient was excluded for pregnancy. 16 underwent preoperative ERCP and 11 underwent combined interventions. There was no difference in patient age between the two groups (p-value 0.77). All patients presented with a diagnosis of acute cholecystitis with or without pancreatitis. Patients who were confirmed or suspected to have choledocholithiasis underwent ERCP either pre-operatively or as a combined procedure. The average length of stay was compared between the two groups. Patients who underwent two separate procedures had an average length of stay of 6 days while patients who underwent a combined procedure with a single anesthetic exposure had an average length of stay of 3.45 days, which was a statistically significant difference with a p-value of 0.05.
Conclusions: This data suggests that there is a benefit both for patient outcomes as well as from the standpoint of cost to performing combined procedures when feasible, even in an urgent setting.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95172
Program Number: P246
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster