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Early cholecystectomy in children with gallstone pancreatitis reduces readmissions
David J Wilkinson1, Nisarg Mehta2, Iain Hennessey3
1Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK; Reproductive and Developmental Medicine, Institute of Child Health, University of Liverpool, Eaton Road, Liverpool, L12 2AP, UK.
Insights
Performing early cholecystectomy (gallbladder removal) within two weeks for pediatric gallstone pancreatitis significantly reduces readmission risk by 57.5%. This timing does not increase surgical complications or mortality in children.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes Research
- Public Health
Background:
- Guidelines for cholecystectomy timing in gallstone pancreatitis are established for adults, but evidence in pediatric populations is limited.
- This study addresses the gap in understanding the impact of surgical timing on pediatric gallstone pancreatitis outcomes.
Purpose of the Study:
- To investigate the effect of the timing of cholecystectomy on hospital readmission rates in children diagnosed with gallstone pancreatitis.
- To evaluate the safety and efficacy of early versus delayed surgical intervention.
Main Methods:
- A retrospective analysis of pediatric patients (<19 years) diagnosed with gallstone pancreatitis in English NHS trusts (1999-2009).
- Data extracted from the Hospital Episode Statistics Database, utilizing ICD-10 and OPCS4.6 codes.
- Analysis focused on diagnosis, age, comorbidities, and subsequent procedures, specifically cholecystectomy timing.
Main Results:
- 670 pediatric cases of gallstone pancreatitis were identified, with 3 deaths.
- Cholecystectomy was performed in 534 patients; 33% underwent surgery within two weeks of admission.
- Early cholecystectomy (within two weeks) demonstrated a significant 57.5% reduction in readmission risk (ARR) (NNT=2), with no increase in operative complications or mortality.
Conclusions:
- Performing cholecystectomy within two weeks of admission for pediatric gallstone pancreatitis is associated with significantly reduced hospital readmissions.
- Early surgical intervention in this pediatric group appears safe, with no increased risk of surgical complications or mortality.
Background:
Multiple guidelines exist in adult practice regarding the timing of cholecystectomy for gallstone pancreatitis. Current evidence to support their application to pediatric practice is minimal. This study sought to determine the effect of timing of cholecystectomy for gallstone pancreatitis in children on the risk of readmission.
Method:
All patients younger than 19years of age presenting to an acute NHS trust in England with a diagnosis of gallstone pancreatitis between 1 January 1999 and 31st December 2009 were included. Patient level data were extracted from the English Hospital Episode Statistic Database. ICD10, OPCS4.6 and hospital administrative data were used to determine: diagnosis, age, associated comorbidities and subsequent procedures performed.
Results:
670 cases of gallstone related pancreatitis were recorded in younger than 19 years old between 1999 and 2009 resulting in 3 deaths during this period. The majority (534/670) underwent a cholecystectomy which was performed less than two weeks from primary admission in 33% (174/534) of cases. Cholecystectomy within two weeks provides an actual risk reduction (ARR) of readmission of 57.5% (95% CI 50.1 to 64.4%, p<0.0001, NNT 2). No significant difference was identified in operative complications or mortality following early cholecystectomy in this group (p>0.05).
Conclusions:
Readmissions can be significantly reduced in this population by performing a cholecystectomy within two weeks with no apparent rise in surgical complications.
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