TPT 8.08 Incidence and Drivers of Post-Cholecystectomy ERCP in a Multi-Hospital Health-Board Cohort: A Retrospective Service-Governance Study
TL;DR
90-day postoperative ERCP incidence was quantified and drivers relevant to pathway design were examined, supporting risk-stratified follow-up and targeted pathway optimisation; ERCP is a marker of case-mix and pathway design.
Abstract
ERCP after laparoscopic cholecystectomy is uncommon but consequential, exposing patients to procedure-related morbidity and consuming endoscopy capacity. UK ERCP quality standards emphasise governance and audit of avoidable repeat procedures. Contemporary pooled data confirm ERCP adverse events remain clinically important. We quantified 90-day postoperative ERCP incidence and examined drivers relevant to pathway design; bile-leak indications are time-sensitive. Retrospective cohort across three acute hospitals in one NHS health board (Jan 2023–Nov 2024). The primary outcome was the first ERCP ≤90 days. Secondary outcomes were ERCP ≤30 days, time to ERCP, and 30-day readmission. Logistic regression included age, non-elective surgery, recorded CBD stones, and subtotal cholecystectomy; sensitivity models adjusted for intraoperative cholangiography and CBD exploration. 792/794 operations had ascertainable 90-day ERCP status. ERCP ≤90 days occurred in 55/792 (6.9%, 95% CI 5.4–8.9) and ERCP ≤30 days in 39/792 (4.9%). Median time to ERCP was 10 days (IQR 4–44). Thirty-day readmission was higher among ERCP cases (25.5% vs 6.1%). Independent drivers were recorded CBD stones (aOR 6.14, 95% CI 3.35–11.25), subtotal cholecystectomy (aOR 7.47, 95% CI 3.79–14.70) and non-elective surgery (aOR 1.94, 95% CI 1.06–3.55); intraoperative cholangiography and CBD exploration were not independently associated. Approximately 1 in 18 patients required ERCP within 90 days. Demand concentrates in stone-phenotype and subtotal cases, supporting risk-stratified follow-up and targeted pathway optimisation; ERCP is a marker of case-mix and pathway design.