Gallstone pancreatitis in older patients: Are we operating enough?

Marc D. Trust, Kristin M. Sheffield, Casey A. Boyd, Jaime Benarroch-Gampel, Dong Zhang, Courtney M. Townsend, Taylor S. Riall

Research output: Contribution to journalArticlepeer-review

52 Scopus citations


Background: The recommended therapy for mild gallstone pancreatitis is cholecystectomy on initial hospitalization. Methods: Using a 5% national Medicare sample (1996-2005), we evaluated adherence to current recommendations for gallstone pancreatitis (cholecystectomy rates on initial hospitalization and the use of endoscopic retrograde cholangiopancreatography [ERCP]/ sphincterotomy). We evaluated predictors of cholecystectomy, gallstone-related readmissions, and 2-year mortality. Results: Adherence to current guidelines was low. Only 57% of 8,452 Medicare beneficiaries presenting to an acute care hospital with a first episode of mild gallstone pancreatitis underwent cholecystectomy on initial hospitalization. Of the patients who did not undergo cholecystectomy, 55% were never evaluated by a surgeon. Likewise, only 28% of patients who did not undergo cholecystectomy had a sphincterotomy. The 2-year readmission rates were higher among patients who did not undergo cholecystectomy (44% vs 4%; P <.0001), and 33% of these patients required cholecystectomy after discharge. In the no cholecystectomy group, ERCP prevented readmissions (hazard ratio, 0.53; 95% confidence interval, 0.47-0.61) and when readmissions occurred they were less likely to be for gallstone pancreatitis in patients who had an ERCP (27.8% vs 53.2%; P <.0001). On multivariate analysis, patients who were older, black, admitted to a nonsurgical service, lived in certain US regions, and had specific comorbidities were less likely to undergo cholecystectomy. Conclusion: Adherence to current recommendations for the management of mild gallstone pancreatitis is low in older patients. Our data suggest that >40% of patients who did not undergo cholecystectomy would have benefited from early definitive therapy. Implementation of policies to increase adherence to guidelines would prevent gallstone-related morbidity and mortality in older patients.

Original languageEnglish (US)
Pages (from-to)515-525
Number of pages11
Issue number3
StatePublished - Sep 2011

ASJC Scopus subject areas

  • Surgery


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