Effectiveness of Guideline-recommended Cholecystectomy in Preventing Recurrent Acute and Chronic Pancreatitis: A Systematic Review.

BACKGROUND

Acute biliary pancreatitis is a frequent cause of hospitalization and is associated with a substantial risk of recurrent pancreatitis if definitive biliary management is delayed or omitted. Clinical guidelines recommend cholecystectomy during the index hospitalization or within an early postdischarge period for patients with mild-to-moderate disease. However, real-world adherence to these recommendations and their effectiveness in preventing recurrent pancreatitis remain incompletely characterized.

OBJECTIVE

The objective of this study was to systematically review evidence evaluating adherence to guideline-recommended cholecystectomy and its effectiveness in reducing recurrent hospitalizations for acute and chronic pancreatitis.

METHODS

This systematic review synthesizes observational evidence derived from a large administrative claims dataset, including 17,010 patients hospitalized with acute biliary pancreatitis between 2010 and 2013. Eligible individuals were identified using standardized diagnostic codes for acute pancreatitis and gallstone disease. Guideline adherence was defined as cholecystectomy performed during the index hospitalization or within 30 days of discharge. Outcomes included subsequent hospitalizations for acute pancreatitis and chronic pancreatitis. Comparative analyses between guideline-adherent and nonadherent groups were evaluated using adjusted Cox proportional hazards models accounting for age, sex, comorbidities, and length of index hospital stay.

RESULTS

Of the 17,010 patients, 78% underwent guideline-adherent cholecystectomy, including surgery during the index hospitalization or within 30 days. Among 3705 nonadherent patients, only 1213 underwent cholecystectomy within 1-6 months after hospitalization. Guideline-adherent cholecystectomy was associated with significantly fewer subsequent hospitalizations for acute pancreatitis (3% vs. 13%, P < 0.001) and chronic pancreatitis (1% vs. 4%, P < 0.001) compared with nonadherence.

CONCLUSION

In this systematic review of 17,010 patients with acute biliary pancreatitis, adherence to guideline-recommended cholecystectomy timing was associated with a marked reduction in recurrent hospitalizations for both acute and chronic pancreatitis. Despite high overall adherence, delayed or absent cholecystectomy remained common among nonadherent patients and was associated with worse outcomes. These findings reinforce the importance of timely cholecystectomy to prevent recurrent pancreatitis.