Experience with same-day endoscopic retrograde cholangiopancreatography and cholecystectomy for choledocholithiasis in United States children's hospitals.

Abstract

Children with choledocholithiasis require bile duct clearance and cholecystectomy. These procedures are often performed in a staged fashion during the same hospitalization because of logistical complexity and concerns that endoscopic manipulation may increase complications. In adults, same-day intervention has been associated with reduced length of stay and cost without increased morbidity, but pediatric data are limited. We sought to evaluate national patterns and outcomes with same-day versus staged management of choledocholithiasis in children. The Pediatric Health Information System database was queried for patients <18 years undergoing both cholecystectomy and endoscopic retrograde cholangiopancreatography between 2021 and 2024. Patients with biliary pancreatitis or an extreme length of stay were excluded. Patients were grouped by whether procedures occurred on the same or different days. Outcomes included length of stay, hospital cost, pancreatitis, surgical and biliary complications, and open cholecystectomy. Multivariable regression adjusted for demographic factors. Among 1,195 patients, 251 (21.0%) underwent same-day procedures and 944 (79.0%) underwent staged management. The median length of stay was shorter in the same-day group (3 vs 4 days, P < .001). After adjustment, staged procedures were associated with a 36.6% longer hospitalization and 13.8% higher costs (P < .001). Rates of pancreatitis (11.2% vs 10.7%), surgical complications (4.8% vs 4.4%), biliary complications (1.2% vs 0.8%), and open cholecystectomy (4.4% vs 3.7%) were similar between groups (all P > .05). There was substantial interhospital variation in same-day utilization (median, 11.8%; range, 0-100%). Same-day management was associated with shorter hospitalization and lower cost without increased complications, supporting this approach for pediatric choledocholithiasis.