title: Early cholecystectomy in children with gallstone pancreatitis reduces readmissions.
abstract: BACKGROUND
  Multiple guidelines exist in adult practice regarding the timing of cholecystectomy for gallstone pancreatitis. Current evidence to support their application to pediatric practice is minimal. This study sought to determine the effect of timing of cholecystectomy for gallstone pancreatitis in children on the risk of readmission.
  
  
  METHODS
  All patients younger than 19years of age presenting to an acute NHS trust in England with a diagnosis of gallstone pancreatitis between 1 January 1999 and 31st December 2009 were included. Patient level data were extracted from the English Hospital Episode Statistic Database. ICD10, OPCS4.6 and hospital administrative data were used to determine: diagnosis, age, associated comorbidities and subsequent procedures performed.
  
  
  RESULTS
  670 cases of gallstone related pancreatitis were recorded in younger than 19 years old between 1999 and 2009 resulting in 3 deaths during this period. The majority (534/670) underwent a cholecystectomy which was performed less than two weeks from primary admission in 33% (174/534) of cases. Cholecystectomy within two weeks provides an actual risk reduction (ARR) of readmission of 57.5% (95% CI 50.1 to 64.4%, p<0.0001, NNT 2). No significant difference was identified in operative complications or mortality following early cholecystectomy in this group (p>0.05).
  
  
  CONCLUSIONS
  Readmissions can be significantly reduced in this population by performing a cholecystectomy within two weeks with no apparent rise in surgical complications.
authors.affiliation: Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK; Reproductive and Developmental Medicine, Institute of Child Health, University of Liverpool, Eaton Road, Liverpool, L12 2AP, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Wilkinson
authors.affiliation: University of Liverpool Medical School, Cedar House, Ashton Street, Liverpool, L69 3GE, UK.
authors.forename: Nisarg
authors.initials: N
authors.lastname: Mehta
authors.affiliation: Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Hennessey
authors.affiliation: Cellular and Molecular Physiology, University of Liverpool, Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK.
authors.forename: David
authors.initials: D
authors.lastname: Edgar
authors.affiliation: Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK; Reproductive and Developmental Medicine, Institute of Child Health, University of Liverpool, Eaton Road, Liverpool, L12 2AP, UK. Electronic address: simon.kenny@liv.ac.uk.
authors.forename: Simon E
authors.initials: SE
authors.lastname: Kenny
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002763:Cholecystectomy; D005260:Female; D042882:Gallstones / Q000150:complications / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010195:Pancreatitis / Q000209:etiology*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cholecystectomy; Gallstone pancreatitis; Outcomes; Pediatrics