Ng Ayesha P, Coaston Troy N, Ali Konmal, de Virgilio Christian, Benharash Peyman
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.
Surg Open Sci. 2025 May 10;26:79-86. doi: 10.1016/j.sopen.2025.05.002. eCollection 2025 Jun.
In the absence of cholangitis, the role of intraoperative cholangiography (IOC) to exclude retained stones in mild gallstone pancreatitis (GSP) remains controversial. Using a nationally representative database, we examined the contemporary utilization of IOC and index outcomes and readmission following cholecystectomy for GSP.
All adults undergoing nonelective cholecystectomy for mild GSP in the 2017-2021 Nationwide Readmissions Database were identified. Patients were stratified based on the use of IOC. Multivariable regressions and Royston-Parmar analysis were used to evaluate the association of IOC use with outcomes of interest.
Of 152,687 patients, 24.7 % underwent IOC. Utilization of IOC significantly decreased from 26.5 % to 20.7 % over the study period ( < 0.001). Compared to patients without IOC, IOC patients were older and more commonly treated at high-volume, private hospitals. Following risk adjustment, the odds of major adverse events, including mortality, complications, and bile duct injury repair were comparable between cohorts. Furthermore, length of stay and hospitalization costs were comparable between patients with and without IOC. Notably, IOC was significantly associated with 20 % decreased odds of 90-day readmission for recurrent pancreatitis or retained stone, which persisted over time (AOR 0.80 [95 % CI 0.74-0.86]).
IOC was associated with significantly reduced readmission and comparable resource use following cholecystectomy for GSP. Despite its decreasing utilization, IOC may be a cost-effective strategy to help reduce risk for recurrent biliary disease among patients with mild GSP.
在无胆管炎的情况下，术中胆管造影（IOC）在排除轻度胆石性胰腺炎（GSP）中残留结石的作用仍存在争议。我们使用一个具有全国代表性的数据库，研究了IOC的当代应用情况以及GSP胆囊切除术后的指标性结局和再入院情况。
在2017 - 2021年全国再入院数据库中识别所有因轻度GSP接受非选择性胆囊切除术的成年人。患者根据IOC的使用情况进行分层。采用多变量回归和Royston - Parmar分析来评估IOC使用与感兴趣结局之间的关联。
在152,687例患者中，24.7%接受了IOC。在研究期间，IOC的使用率从26.5%显著下降至20.7%（P < 0.001）。与未接受IOC的患者相比，接受IOC的患者年龄更大，更常在高容量的私立医院接受治疗。经过风险调整后，各队列之间包括死亡率、并发症和胆管损伤修复在内的主要不良事件发生率相当。此外，接受IOC和未接受IOC的患者住院时间和住院费用相当。值得注意的是，IOC与复发性胰腺炎或残留结石导致的90天再入院几率显著降低20%相关，且这种关联随时间持续存在（调整后比值比0.80 [95%置信区间0.74 - 0.86]）。
对于GSP患者，IOC与胆囊切除术后再入院显著减少及资源使用相当相关。尽管其使用率在下降，但IOC可能是一种具有成本效益的策略，有助于降低轻度GSP患者复发性胆道疾病的风险。
