Index Cholecystectomy for Acute Cholangitis Shows Better Outcomes versus Delayed

Ng AP, Ali K, Coaston T, et al. National Analysis of Outcomes in Timing of Cholecystectomy for Acute Cholangitis. Am J Surg. 2024; in press.

Ayabe RI, Eng OS. The Cost of Waiting: Index vs. Delayed Cholecystectomy for Acute Cholangitis. Am J Surg. 2024; in press.

Acute cholangitis is a potentially life-threatening illness, and management is guided by the Tokyo Guidelines. Control of associated sepsis is accomplished first, followed by biliary decompression.

Cholecystectomy is recommended in stable patients, but timing of the intervention is a debated topic.

This study reported data from a national database (n = 65,753) to compare outcomes of cholecystectomy performed during the index admission to outcomes following delayed cholecystectomy. Index admission cholecystectomy occurred in 82% of included patients.

The data showed that delayed cholecystectomy was associated with significantly elevated mortality risk, complication rates, and readmissions. Overall costs associated with delayed cholecystectomy were also higher.

The authors concluded that index-admission cholecystectomy was associated with reduced adverse outcomes and was a potentially safe option for management of patients with acute cholangitis.

The editorial by Ayabe and Eng that accompanied the article emphasized that the delayed cholecystectomy group was comprised of higher risk patients. Despite the lack of strong data, available evidence supports the practice of index cholecystectomy in acceptable risk patients.