Pediatric Cholecystectomy: A Quality Improvement Initiative to Reduce Delays and Imaging Utilization

Delays in surgical management of pediatric gallstone disease remain common. This quality improvement initiative evaluated contributors to delayed surgical management and implemented a standardized care protocol to improve hospital length of stay (LOS), time to cholecystectomy (TTC), and imaging utilization.

We conducted a two-phase quality improvement initiative at two pediatric hospitals within the same health system. Phase 1 was a retrospective cohort study of children ≤18 y old who underwent semiurgent cholecystectomy during admission for symptomatic cholelithiasis. Associations between hospital LOS and TTC and patient, clinical, and system-level factors were analyzed using multivariable logistic regression. Phase 1 findings informed a standardized algorithm, emphasizing early surgical consultation and risk stratification for choledocholithiasis. Phase 2 compared LOS, TTC, and preoperative magnetic resonance cholangiopancreatography (MRCP) utilization before and after implementation.

Among 187 preimplementation patients, 45% presented to the emergency department (ED) and 55% were transferred. Surgical consultation at presentation occurred in 74% of ED and 27% of transfers. Multivariable analysis demonstrated lower odds of LOS >2 d (odds ratio: 0.29, 95% confidence interval: 0.13-0.66) and TTC >2 d (odds ratio: 0.31, 95% confidence interval: 0.14-0.69) with early surgical consultation, independent of diagnosis, and point of entry. Following protocol implementation, median LOS decreased from 3 to 2 d and median TTC from 2 to 1 d (P < 0.001). MRCP utilization decreased from 39% to 24% (P = 0.013).

Implementation of a standardized, surgery-directed care pathway was associated with reduction in LOS, TTC, and MRCP utilization, supporting broader implementation and further refinement of pediatric choledocholithiasis risk stratification strategies.