Many patients who decline cholecystectomy for pancreatitis fare well

Paul Basilio, MDLinx | April 04, 2017

Incidental findings from a new study by Johns Hopkins researchers showed that many patients who did not have their gallbladders removed while hospitalized with acute biliary pancreatitis fared well for years.

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These findings could lead to fewer gallbladder removals.

The study was initially created as the largest-ever evaluation of adherence to accepted medical guidelines for pancreatitis hospitalizations. Results were published in the American Journal of Gastroenterology, and could have important implications for the field of personalized medicine.

Cholecystectomy remains the standard treatment for patients hospitalized for acute biliary pancreatitis. It is recommended within 4 weeks of the initial diagnosis due to the risk of organ failure, sepsis, and other complications.

However, 70% of the patients in the study who declined surgery were not hospitalized again for pancreatitis.

“These findings tell us that there may be a way to avoid gallbladder removal surgery,” says Susan Hutfless, PhD, Assistant pProfessor of Medicine at the Johns Hopkins University School of Medicine and principal investigator of the study.

Dr. Hutfless and lead author Ayesha Kamal, MBBS, a postdoctoral fellow in the Department of Medicine at Johns Hopkins, examined more than 17,000 cases in the US between 2010 and 2013. Patients in the study had private insurance and were under the age of 65.

Almost 80% of patients underwent cholecystectomy within 30 days of their initial hospitalization, which is in line with accepted guidelines. Less than 10% of those patients returned to the hospital with pancreatitis. Of the 3,705 patients who initially declined cholecystectomy, 30% ended up undergoing the procedures within 6 months.

However, nearly 2,500 patients who did not have the surgery within 30 days had still not had it after 4 years of follow-up.

The authors note that patients with acute biliary pancreatitis face a number of barriers to compliance with physician recommendations, such as a lack of resources, surgeon or patient preference, and inaccurate billing coding. Kamal said that with nearly 80% of those patients undergoing the procedure, the compliance rate was unexpectedly high.

Dr. Hutfless also cautioned that more research is necessary before drawing conclusions from the noncompliance findings.

“This paper shows that as medicine evolves, it is important to reflect on opportunities to refine care further,” she explained. “The personalization of cholecystectomy timing is still a hypothesis and would need to be tested in rigorous studies. For now, there is clear evidence that the guidelines are beneficial to patients and should be followed.”

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