# National trends in utilization and readmission following intraoperative cholangiography in gallstone pancreatitis

## TL;DR

This study examines how often intraoperative cholangiography is used during gallstone pancreatitis surgery and its impact on patient outcomes and readmissions.

## Contribution

The study provides new national trends and evidence on the effectiveness of intraoperative cholangiography in reducing readmissions for gallstone pancreatitis.

## Key findings

- Use of intraoperative cholangiography decreased from 26.5% to 20.7% between 2017 and 2021.
- Intraoperative cholangiography was associated with a 20% reduced odds of 90-day readmission for recurrent pancreatitis or retained stones.
- Mortality, complications, length of stay, and costs were comparable between patients who received and did not receive intraoperative cholangiography.

## Abstract

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 (p < 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.

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•Utilization of intraoperative cholangiography decreased from 2017 to 2021.•Mortality and complications were comparable regardless of cholangiography use.•Length of stay and total costs were similar regardless of cholangiography use.•Intraoperative cholangiography demonstrated 20 % reduced odds of 90-day readmission.

Utilization of intraoperative cholangiography decreased from 2017 to 2021.

Mortality and complications were comparable regardless of cholangiography use.

Length of stay and total costs were similar regardless of cholangiography use.

Intraoperative cholangiography demonstrated 20 % reduced odds of 90-day readmission.