Outcomes of Same Admission Cholecystectomy and ERCP for Common Bile Duct Stones: A Post-Hoc Analysis of an EAST Multicenter Study

BACKGROUND The optimal timing for cholecystectomy after ERCP for common bile duct (CBD) stones is unknown. We hypothesized that a delay between procedures would correlate with more biliary complications and longer hospitalizations. METHODS We prospectively identified patients who underwent same admission cholecystectomy after ERCP for CBD stones from 2016-2019 at 12 U.S. medical centers. The cohort was stratified by time between ERCP and cholecystectomy: ≤ 24 hours (immediate), > 24 to ≤ 72 hours (early), and > 72 hours (late). Primary outcomes included operative duration, postoperative length of stay (LOS), and hospital LOS. Secondary outcomes included rates of open conversion, CBD explorations, biliary complications, and in-hospital complications. RESULTS For the 349 patients comprising the study cohort; 33.8% (n = 118) were categorized as immediate, 50.4% (n = 176) as early, and 15.8% (n = 55) as late. Rates of CBD explorations were lower in the immediate group compared to the late group (0.9% vs 9.1%, p = 0.01). Rates of open conversion were lower in the immediate group compared to the early group (0.9% vs 10.8%, p < .01) and in the immediate group compared to the late group (0.9% vs 10.9%, p <.001). On a mixed model regression analysis, an immediate cholecystectomy was associated with a significant reduction in postoperative LOS (β 0.79, 95% CI 0.65-0.96, p = 0.02) and hospital LOS (β 0.68, 95% CI 0.62-0.75, p < .0001). CONCLUSION An immediate cholecystectomy following ERCP correlates with a shorter postoperative LOS and hospital LOS. Rates of CBD explorations and conversion to open appear more common after 24 hours. LEVEL OF EVIDENCE II, therapeutic.