S2215 Impact of Elective Cholecystectomy Following ERCP on Readmission Rates in Elderly Patients With Choledocholithiasis: A Nationwide Analysis

Introduction: Choledocholithiasis is common in elderly patients, yet cholecystectomy is often deferred due to perceived surgical risks. This study evaluates whether combining cholecystectomy with ERCP reduces 30-day readmissions in elderly patients with choledocholithiasis. Methods: A retrospective analysis of the 2021 National Readmission Database (NRD) included patients aged ≥65 with choledocholithiasis. Groups were stratified by ERCP alone versus ERCP plus cholecystectomy. Outcomes included 30-day readmission, mortality, and discharge disposition. Weighted analyses adjusted for confounders. Results: Among 28,424 patients, 18,188 underwent ERCP alone, and 10,236 had both procedures. The ERCP-only group was older (83.3 vs 81.7 years, P < 0.001) and had more women (55.8% vs 51.9%, P < 0.001). The 30-day readmission rate was higher in the ERCP-only group (10.0% vs 6.4%, P < 0.0001), with higher mortality (2.9% vs 1.1%, P < 0.0001). Adjusted analysis showed a 56.29% higher readmission risk without cholecystectomy (OR 1.5629, 95% CI 1.4242–1.7150, P < 0.0001). Conclusion: Concurrent cholecystectomy with ERCP significantly reduces readmissions and mortality in elderly patients. These findings support integrating cholecystectomy into choledocholithiasis management for this population. Further research should optimize timing and assess long-term outcomes.