Abstract
To assess the comparative outcomes, resource utilization, and overall impact of same-admission cholecystectomy in pediatric patients with acute biliary pancreatitis (ABP) relative to adults.
Using the 2016-2020 National Readmission Database, we identified ABP patients via ICD-10 codes and compared local and systemic complications in adults (≥18) versus pediatric (<18) patients. Proportions were analyzed using Fisher's exact test, and multivariate logistic regression was performed, adjusting for age, gender, comorbidities, procedure volume, and patient and hospital factors. Readmission trends were assessed with the Mantel-Haenszel test. Analyses used Stata 14.2; P<0.05 was significant.
Among 194,441 ABP patients, 1.54% (n=2,999) were pediatric. Systemic complications of acute pancreatitis were similar, except sepsis was higher in adults (1.72% vs. 0.41%, P<0.01). Local complications, including pseudocyst, pancreatic necrosis, and walled-off necrosis, were comparable. Mortality was 0% vs. 0.71% (P=0.22). Same-admission cholecystectomy (CCY) was more common in pediatric cases; ERCP in adults. CCY reduced 30-day readmissions in both groups (11.81%→5.55% pediatric; 11.99%→4.44% adults, P<0.05). Pediatric CCY rates were stable longitudinally during study period; adult rates slightly increased (56.51%→57.23%, trend P=0.01).
Despite higher comorbidities in adults, ABP-specific local and systemic complications and mortality were similar between adults and pediatric patients. Same-admission cholecystectomy (CCY) was associated with a significant reduction in 30-day readmissions in both groups, highlighting its importance as a key intervention across age groups in acute biliary pancreatitis (ABP) cases.