Gallstone pancreatitis: Does discharge and readmission for cholecystectomy affect outcome?

Abstract

Background: Conventional surgical wisdom is that a patient with gallstone pancreatitis should have the gallbladder removed during their initial hospitalization. However, patients are now often discharged to await operating room availability. Methods: A retrospective review of all cases of gallstone pancreatitis at the Foothills Hospital between 1992 and 1996 was undertaken. Patients with a first attack of mild gallstone pancreatitis were studied. Results: In all, 164 patients were identified: 90 patients were discharged for readmission cholecystectomy (discharged group), and 74 patients had the cholecystectomy before discharge (in-hospital group). Over the 5-year time period the proportion of patients discharged for readmission cholecystectomy increased from 27% to 67% (p < 0.01). The total number of days waited for operation was greater in the discharged group versus in-hospital group: 40 ± 69 days versus 8 ± 10 days respectively (mean ± SD). There was a trend towards an increased total number of days in hospital in the in-hospital group, 15.5 ± 17 days versus 10.7 ± 16 days. In the discharged group 20% (18 of 90) of patients experienced an adverse event requiring readmission while awaiting operation. Three had documented recurrent pancreatitis, 10 experienced recurrent pain, and 5 developed acute cholecystitis. There were no deaths in either group. Discussion: Twenty percent of patients with gallstone pancreatitis who are discharged to await operating room time (average wait 40 days) will require readmission for biliary symptoms.