SP 7.06 Socioeconomic Deprivation and Time to Definitive Management After ERCP for Common Bile Duct Stones: A Retrospective Cohort Study with Contemporaneous Single-Stage Laparoscopic Common Bile Duct Exploration Cases
TL;DR
In this ERCP cohort, socioeconomic deprivation was associated with slower progression to definitive surgery and greater downstream bed-day utilisation, suggesting inequality in access to definitive gallstone care and should inform pathway design and capacity planning.
Abstract
Socioeconomic deprivation may influence access to definitive gallstone care after ERCP for choledocholithiasis. We evaluated the association between the Scottish Index of Multiple Deprivation (SIMD) and progression to cholecystectomy, and downstream healthcare utilisation, in a contemporary ERCP cohort. Retrospective analysis of adults undergoing ERCP for choledocholithiasis between January 2023 and December 2024. SIMD quintiles were used (Q1 most-deprived, Q5 least-deprived). The primary outcome was time from ERCP to cholecystectomy, analysed using Cox proportional hazards regression. Secondary outcomes were acute biliary readmissions, repeat ERCP, biliary imaging, and additional bed-days, analysed using negative binomial models with person-time offsets and adjustment for age, sex, ASA grade, and Charlson comorbidity index. The cohort comprised 356 patients (mean age 70.7±13.5 years; 200/356 [56.2%] female). SIMD data were available for 353/356 (99.2%). Post-ERCP cholecystectomy occurred in 81/356 (22.8%); among those with recorded dates (n=80), the median time from ERCP to cholecystectomy was 104 days (IQR 49–224). In adjusted Cox regression, each higher SIMD quintile (less deprivation) was associated with faster progression to cholecystectomy (aHR 1.22, 95% CI 1.03–1.44, p=0.021). In adjusted utilisation models, a higher SIMD quintile was associated with lower additional bed-days (aIRR 0.90, 95% CI 0.82–0.98, p=0.021), while associations with readmissions, repeat ERCP, and imaging were not statistically significant. In this ERCP cohort, socioeconomic deprivation was associated with slower progression to definitive surgery and greater downstream bed-day utilisation. These findings suggest inequality in access to definitive gallstone care and should inform pathway design and capacity planning.