- Design
- Retrospective cohort, US Nationwide Readmissions Database 2016–2020
- Population
- 13,517 children admitted with gallstone pancreatitis
- Primary outcome
- 60-day readmission
- Effect
- 4.4% with cholecystectomy vs 24.8% with no intervention; aHR 0.16 (0.1–0.2)
Using a US national readmission database from 2016 to 2020, researchers identified 13,517 children admitted with gallstone pancreatitis and compared 60-day readmission according to whether they had cholecystectomy, ERCP, both or neither before discharge.
Overall, about one in eight was readmitted within 60 days. Children discharged without any intervention were readmitted in about 25% of cases, against 4.4% after cholecystectomy and 3.7% after both cholecystectomy and ERCP. ERCP alone helped less, with about 15% readmitted. Readmissions with severe pancreatitis were also fewer after cholecystectomy.
Same-admission cholecystectomy is established in adults, but practice in children has been less consistent, partly because paediatric gallstone disease is less common and teams are less familiar with it. These data suggest children follow the adult pattern.
This was observational, so sicker children may have been less likely to have surgery, which would exaggerate the difference. But the size of the gap is large, and it is consistent with adult evidence. For a child with mild gallstone pancreatitis, plan cholecystectomy before discharge unless there is a clear reason not to.
- Consider cholecystectomy before discharge for children with mild gallstone pancreatitis.
- Involve paediatric surgery early in the admission rather than at follow-up.
- Use ERCP when there is ongoing obstruction or cholangitis; it does not replace cholecystectomy.
- If surgery must wait, book it before the child leaves hospital.
- Tell families that recurrence is common while the gallbladder remains.
Why it matters
It removes the main reason paediatric teams have given for treating children differently from adults here.
Don't overread it
Observational database data; it cannot confirm that surgery alone explains the fewer readmissions.
The statistics, in plain English
An adjusted hazard ratio of 0.16 means the rate of readmission was about one-sixth of that with no intervention. Because the treatment was not randomised, unmeasured differences between children who did and did not have surgery could explain part of this, though probably not a gap this large.
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