Same-Admission Cholecystectomy Is Safe and Effective for Patients with Concurrent Choledocholithiasis and Cholangitis

Although guidelines recommend early cholecystectomy (CCY) after ERCP for choledocholithiasis-associated cholangitis, surgery is frequently deferred, particularly in severe disease. We evaluated real-world outcomes and decision-making between same-admission versus deferred CCY to assess the impact of surgical delay.

We conducted a retrospective cohort study on patients with choledocholithiasis-associated cholangitis from 2011 to 2022. Primary outcomes were the occurrence of ≥ 1 recurrent biliary event (RBE) within one year, and 30-day mortality and readmissions. Secondary outcomes included operative complications, length of stay, and reasons for delay. Multivariable logistic regression adjusted for age, comorbidities, sex, and severity, with subgroup analyses for Grade III cholangitis. Kaplan-Meier survival analysis evaluated time to first RBE.

Among 171 patients (mean [SD] age, 66.2 [19.1] years; 85 [49.7%] female), 94 (55%) had CCY deferred. Same-admission CCY was associated with lower odds of RBEs (aOR 0.01; 95% CI 0-0.08; p < 0.001) and 30-day readmission (1.3% vs. 13.8%; aOR 0.11; 95% CI 0.01-0.48; p = 0.0023), with similar complication rates and length of stay. Kaplan-Meier analysis confirmed superior RBE-free survival for same-admission CCY (log-rank p < 0.001). Among patients with Grade III cholangitis (n = 34), same-admission CCY reduced RBE rate (0% vs. 56.5%; p < 0.001) without increasing intraoperative or postoperative complications. Deferral was most often due to high surgical risk (21.3%), concurrent pathology (20.2%), or patient preference (14.9%).

Same-admission CCY for choledocholithiasis-associated acute cholangitis reduced recurrence and 30-day readmission without increasing postoperative complications, mortality, or length of stay, including in Grade III cholangitis. These findings support same-admission CCY after clinical stabilization.