S120 Evaluating the Safety and Efficacy of Same-admission Cholecystectomy in Elderly Patients With Non-Severe Acute Cholangitis

Introduction: The Tokyo Guidelines 2018 for acute cholangitis (AC) recommend prompt biliary drainage and antibiotics as first-line management, followed by cholecystectomy (CCY) in gallstone-related cases to prevent recurrence. Although same-admission CCY is advocated, its utilization remains limited, particularly in elderly patients. This study explored the rates and outcomes of same-admission CCY in non-severe AC across different age groups. Methods: Using the National Readmission Database (2019), we employed the International Classification of Diseases-10 codes to identify adult patients with AC who underwent endoscopic retrograde cholangiopancreatography during index admission. Non-severe AC was defined as the absence of encephalopathy, shock, renal failure, respiratory failure, or intensive care unit admission. Patients were categorized into 3 age groups (18-49, 50-64, and ≥65 years), and further divided into 2 groups within each age category: those who underwent same-admission CCY and those who did not. Multivariate regression was used to analyze the outcomes. Results: We included 20,538 patients with non-severe AC, of whom 15.2% underwent same-admission CCY. The rates of same-admission CCY decreased with age: 19.82% in 18-49 years, 14.71% in 50-64 years, and 14.04% in those ≥65 years. We found that there was no reduction in the mortality rates with same-admission CCY in any of the age groups. The length of hospital stay and hospitalization charges were higher in the patients undergoing CCY across all age groups. However, CCY during the index admission was associated with reduced 30-day readmission rates in all age groups. Finally, no significant difference in perioperative complications was observed among the age groups. Conclusion: Our findings highlight the readmission benefits of same-admission CCY across all age groups in patients with non-severe AC, without any increase in the risk of perioperative complications in the elderly cohort, substantiating the safety of same-admission CCY in older adults with non-severe AC. Nevertheless, despite these aforementioned benefits, we found disparities in the implementation of same-admission CCY in elderly patients with non-severe AC. The observed disparity in the performance of same-admission cholecystectomy among older adults warrants further investigation into the factors influencing clinical decision making in this population.