Cholecystectomy at the index admission decreases 60-day readmission rates in pediatric gallstone pancreatitis

Background In adults with gallstone pancreatitis, cholecystectomy (CCY) at the index admission reduces recurrence and readmissions. While pediatric cases have higher rates of obstruction and cholangitis, the impact of early CCY remains unclear. We examined a nationwide readmission database to assess outcomes in pediatric patients admitted with gallstone pancreatitis. Methods We analyzed the national readmission database (NRD) abstracting pediatric patients with the principal discharge diagnosis of biliary and gallstone pancreatitis from 2016 to 2020. Patients were divided into four groups: (1) No CCY/No ERCP, (2) No CCY/Yes ERCP, (3) Yes CCY/No ERCP, and (4) Yes CCY/Yes ERCP. Multivariate Cox regression analysis was performed to identify predictors of 60-day readmissions. Results Among 13,517 patients, the 60-day readmission rate was 11.8% (1,589 patients). Higher readmission risk was linked to intact gallbladders, pancreatitis severity, and hospital characteristics. CCY significantly decreased readmission rates compared to no intervention, 4.4 vs. 24.8%; aHR 0.16 (0.1–0.2), p < 0.001. In patients discharged without CCY, ERCP decreased the readmission rate from 24.8 to 14.85%; aHR 0.6 (0.4–0.8), p = 0.001. Patients undergoing both CCY and ERCP demonstrated a further decrease in readmissions from 24.8 to 3.7%; aHR 0.1 (0.1–0.2), p < 0.001. Patients who underwent CCY had fewer readmissions for severe pancreatitis at 3.7% compared to no intervention at 6%. No deaths were reported in the readmission sample. The mean hospitalization charges on readmission in patients discharged with intact gallbladders were $50,141 (95% CI 44,859–55,422), while those that underwent CCY were $44,200 (95% CI 37,324–51,166), and CCY and ERCP were $46,113 (95% CI 34629–57,597). Conclusions Cholecystectomy at the index admission in pediatric gallstone pancreatitis decreased the readmission rate five to sixfold compared to no intervention. If no CCY was performed, ERCP decreased the readmission rate relative to no intervention. The greatest reduction in readmission rates was observed in patients undergoing both CCY and ERCP. For pediatric patients admitted with biliary and/or gallstone pancreatitis, CCY should be strongly considered at the index admission.