Non-Operative Management of Cholecystitis in Pregnant Patients Remains Common

<b><i>Background:</i></b> Cholecystectomy is the recommended treatment for acute cholecystitis in pregnancy, leading to fewer pregnancy-related complications than non-operative management. However, past research demonstrated high rates of non-operative management despite these recommendations. Rates of cholecystostomy tube usage and outcomes in pregnancy are not well described. We hypothesized that rates of interventions for cholecystitis have increased over time. <b><i>Patients and Methods:</i></b> The National Readmissions Database was queried for all visits in the first three quarters of each year 2016 to 2019, which included a patient with an International Classification of Diseases-10 code for cholecystitis and pregnancy. These entries were then further investigated for demographics, gestation, rates of interventions at the index admission (cholecystectomy or cholecystostomy tube), 90-day readmissions, interventions at readmission, and pregnancy-related complications. <b><i>Results:</i></b> Annual rates of interventions for cholecystitis remained low over the study period (27.0%-34.9%). Of patients treated with non-operative management, 6.0% had cholecystectomy on readmission. Compared with the first trimester, interventions were more likely in the second trimester (p < 0.001) and less likely in the third trimester (p < 0.001). Length of stay was highest for cholecystostomy tube placement and lowest for patients who received non-operative management. <b><i>Conclusions:</i></b> Cholecystectomy rates in pregnancy remain low despite evidence that cholecystectomy is safe. Cholecystostomy appears to be a safe alternative but associated with a longer length of stay. Further study is needed to determine what barriers exist to adequate treatment of cholecystitis in pregnant patients.