Racial disparities in the rate of same-admission cholecystectomy following biliary pancreatitis

Same-admission cholecystectomy in mild and moderate biliary pancreatitis is known to be associated with reduced rates of recurrent biliary complications. While practice guidelines recommend same-admission cholecystectomy, the contemporary management of mild and moderate biliary pancreatitis remains unknown. The objective of this study is to assess practice patterns of same-admission cholecystectomy following mild and moderate biliary pancreatitis.

The National Inpatient Sample was queried for patients (age ≥ 18 years) with biliary pancreatitis between January 2016 and December 2021. The Modified Bedside Index for Severity in Acute Pancreatitis was used to identify patients with mild and moderate pancreatitis. Management strategies included non-operative management (NOM) and same-admission cholecystectomy. Multivariable Cox regression evaluated the association between clinical variables and same-admission cholecystectomy.

A total of 482,705 patients with mild and moderate pancreatitis were identified, with 283,435 (59%) undergoing same-admission cholecystectomy. Compared to White patients, Black patients were younger (54 years [interquartile range: 37-66] vs. 63 years [47-75], p < 0.001), more likely to be female (69% vs. 57%, p < 0.001), and had lower Elixhauser Comorbid Index (ECI) (3 [0-10] vs 3 [0-10], p = 0.013). Multivariable Cox regression showed that younger age (hazard ratio [HR] 0.993 per 1-year increment, 95% confidence interval (CI) 0.993-0.994, p < 0.001), female sex (HR 1.157, 95% CI 1.136-1.178, p < 0.001), lower ECI (HR 0.947, 95% CI 0.946-0.948, p < 0.001), and White race (HR 1.208, 95% CI 1.171-1.247, p < 0.001) as well as Hispanic (HR 1.320, 95% CI 1.274-1.368, p < 0.001) as compared to Black race had increased likelihood of undergoing same-admission cholecystectomy.

Despite current recommendations, same-admission cholecystectomy was found to be underutilized in mild and moderate pancreatitis and was less likely to be performed in Black patients compared to White and Hispanic patients.