Researchers observed “unexpectedly high” adherence to guidelines recommending cholecystectomy within 4 weeks for acute biliary pancreatitis, which effectively reduced subsequent hospitalizations.
However, most patients who failed to undergo guideline-recommended cholecystectomy did not require a subsequent cholecystectomy through 4 years of follow-up, suggesting that there may be predictive factors for identifying patients who require the procedure.
“These findings tell us that there may be a way to avoid gallbladder removal surgery,” Susan Hutfless, PhD, assistant professor of medicine at the Johns Hopkins University School of Medicine, said in a press release.
Hutfless and colleagues reviewed 2010-2013 claims data on 17,010 patients with acute biliary pancreatitis, 78% of whom underwent cholecystectomy within 30 days of their index hospitalization per guideline recommendations (10,918 during index hospitalization; 2,387 within 30 days).
Conversely, 3,705 patients were non-adherent to the guidelines, meaning they never underwent cholecystectomy or they had the procedure more than 30 days after their index hospitalization.
Lack of resources, surgeon or patient preference, and inaccurate coding are possible reasons for non-adherence, the investigators wrote.
Compared with non-adherence, adherence to the guideline recommendations significantly reduced subsequent hospitalizations for both acute pancreatitis (3% vs. 13%; P < .001) and chronic pancreatitis (1% vs. 4%; P < .001).
However, less than a third of the non-adherent patients (n = 1,213) required a subsequent cholecystectomy within 1 to 6 months after their index hospitalization, and 67% of them did not require the procedure during the 4 years of follow-up. The reasons for this are unclear, the researchers wrote.
“This paper shows that as medicine evolves, it is important to reflect on opportunities to refine care further,” Hutfless said in the press release. “The personalization of cholecystectomy timing is still a hypothesis and would need to be tested in rigorous studies. For now, there is clear evidence that the guidelines are beneficial to patients and should be followed.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.