Effect of prophylactic biliary stent in reducing recurrence of adverse events among patients awaiting cholecystectomy: an analysis of the Nationwide Readmissions Database

Abstract

Background and Aims

In patients awaiting cholecystectomy, the role of endoscopic biliary sphincterotomy (EST) with biliary stenting is controversial. We aimed to assess the impact of biliary stenting in these patients.

Methods

The Nationwide Readmissions Database (2016-2020) was queried to identify adult hospitalizations with cholelithiasis and choledocholithiasis that underwent ERCP with EST without biliary stenting (group 1) and biliary stenting (group 2). Readmission characteristics, post-ERCP pancreatitis (PEP), mean length of hospital stay (LOS), and mean total hospitalization charge (THC) were analyzed.

Results

For all biliary events, the risks of 30-day (1.18% vs .67%; adjusted hazard ratio [aHR], 1.78, 95% confidence interval [CI], 1.55-2.04; P < .001), 60-day (2.12% vs 1.04%; aHR, 2.0; 95% CI, 1.82-2.28; P < .001), and 90-day (2.66% vs 1.27%; aHR, 2.07; 95% CI, 1.86-2.30; P < .001) readmissions were higher in group 2 than in group 1. Similarly, the risks of 30-, 60-, and 90-day readmissions for choledocholithiasis, cholecystitis, cholangitis, and gallstone pancreatitis, and mean LOS and THC were higher in group 2 than in group 1. After adjusting for confounders, group 2 had higher rates of readmission for PEP within 48 hours after hospital discharge (.05% vs .03%; adjusted odds ratio, 1.93; 95% CI, 1.05-3.52; P = .032) compared with group 1, whereas there was no statistical difference in the rates of PEP from 48 hours to 7 days after hospital discharge between the groups.

Conclusions

For biliary events, patients with biliary stenting had higher readmission risk, LOS, THC, and PEP within 48 hours after discharge compared with nonstented patients.