- Design
- Retrospective analysis of the National Inpatient Sample, 2016 to 2021
- Population
- 482,705 adults with mild or moderate biliary pancreatitis
- Primary outcome
- Same-admission cholecystectomy
- Effect
- 59% overall; White vs Black HR 1.21 (1.17 to 1.25); Hispanic vs Black HR 1.32
Using the US National Inpatient Sample from 2016 to 2021, this study identified 482,705 adults with mild or moderate biliary pancreatitis. Only 59% had cholecystectomy during the same admission, despite guidelines recommending it.
In multivariable analysis, same-admission surgery was more likely in women (HR 1.16), in younger and less comorbid patients, and in White (HR 1.21) and Hispanic (HR 1.32) patients compared with Black patients.
The cost of discharge without cholecystectomy is recurrent biliary events, which is why guidelines recommend same-admission surgery for mild disease. This is an administrative dataset without detail on why surgery was deferred, but the gap is large enough that every unit should check its own rate.
- Plan cholecystectomy in the same admission for mild biliary pancreatitis once pain settles
- Record a clear reason in the notes whenever surgery is deferred
- Audit your unit's same-admission rate; nationally only 59% were done
- Check that deferral decisions are applied equally across patient groups
Why it matters
A guideline most surgeons agree with is being followed in barely more than half of patients.
Don't overread it
Administrative data cannot show why surgery was deferred; some deferrals will have been appropriate.
The statistics, in plain English
A hazard ratio of 1.21 means White patients were about 21% more likely at any point to have same-admission surgery than Black patients, after adjusting for the factors measured.
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