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Published on: January 31, 2025
Association Between Hepatobiliary Scintigraphy and Delays in Operative Management in Acute Cholecystitis
Shelley Warner1, Andy Aleman Espino1, Stacey L Tannenbaum1
1General Surgery, Broward Health Medical Center, Fort Lauderdale, USA.
Cureus
|August 12, 2026
Summary
Hepatobiliary iminodiacetic acid (HIDA) scans for acute cholecystitis significantly delay surgery by over 24 hours compared to ultrasonography alone. These scans should be reserved for equivocal cases to improve patient care timelines.
Area of Science:
- Medical Imaging
- Surgical Workflow Optimization
- Gastroenterology
Background:
- Ultrasonography (US) is the primary imaging for acute cholecystitis.
- Hepatobiliary iminodiacetic acid (HIDA) scans are typically reserved for equivocal cases but are often overutilized.
- Overutilization of HIDA scans may lead to delays in patient care.
Purpose of the Study:
- To evaluate the impact of HIDA scans on time to surgery (TTS) and length of stay (LOS) in acute cholecystitis patients.
- To determine if HIDA scans contribute to delays in surgical management.
- To assess the continued necessity of HIDA scans in current clinical practice.
Main Methods:
- Retrospective cohort study of adult patients undergoing cholecystectomy between January 2019 and December 2020.
- Patients stratified by preoperative imaging: US only vs. US and HIDA scan.
- Primary outcomes: TTS and LOS. Secondary outcome: complicated gallbladder disease. Analysis included t-tests and multivariable linear regression.
Main Results:
- Mean TTS was significantly longer for patients who underwent HIDA scans (68.4 hours) compared to US only (54.1 hours, p=0.039).
- This delay was more pronounced in uncomplicated cases (59.5 hours with HIDA vs. 31.2 hours without, p=0.001).
- HIDA scan use and elevated bilirubin independently predicted increased TTS, while ethnicity predicted shorter TTS. LOS did not differ significantly between groups.
Conclusions:
- HIDA scans are associated with a significant delay in operative management for acute cholecystitis, extending surgical timing by over 24 hours in this cohort.
- Findings suggest HIDA scans continue to prolong surgical timing despite workflow advancements.
- Ordering of HIDA scans should be restricted to equivocal cases to prevent unnecessary delays in patient care.
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