Pediatric acute cholecystitis: Risk factors and outcomes

Abstract

BACKGROUND

Pediatric acute cholecystitis is a growing concern due to rising childhood obesity rates and associated metabolic abnormalities.

AIM

To identify demographic and clinical risk factors, evaluate surgical outcomes, and analyze the impact of complications on hospitalization in pediatric patients undergoing cholecystectomy.

METHODS

A retrospective study was conducted on 12750 pediatric patients who underwent cholecystectomies in 2022. Data were collected from a de-identified National Surgical Quality Improvement Program database, including age, gender, race, body mass index (BMI) status, clinical presentation, complications, and treatment details. Risk factors were assessed using logistic regression, and Kaplan-Meier analysis was used to evaluate postoperative readmission rates. Descriptive statistics explored demographic patterns and surgical outcomes.

RESULTS

Out of 12750 pediatric patients, the mean age was 12.8 years, with a median of 13.0 years. Gender distribution included 74.8% females and 25.2% males. Obesity (BMI ≥ 30 kg/m²) was observed in 36.3% of cases, and overweight (BMI: 25-29.9 kg/m²) in 58.2%. 1232 (9.6%) had a hemolytic disorder. 20% presented with elevated bilirubin levels. Laparoscopic cholecystectomy alone was performed in 84%, while cholangiogram and ductal interventions were performed in 16%. Complication rates included gallbladder perforation (8%), biliary abscess formation (5%), and sepsis (2%). Early cholecystectomy (< 2 days post-diagnosis) was associated with reduced hospital stays (median 1.0 day) and lower readmission rates (5%) compared to delayed surgery (> 5 days; median 3.0 days, readmission rate 12%). Approximately 33.5% of patients were identified as Hispanic, highlighting potential disparities in healthcare access.

CONCLUSION

Pediatric acute cholecystitis is an emerging public health concern linked to rising obesity rates. Early surgical intervention minimizes complications and reduces hospitalization durations. Pediatric-specific adaptations in the Tokyo Guidelines 2018 may be necessary to account for age-related differences in clinical presentation and facilitate accurate diagnosis. Addressing racial disparities and targeted prevention strategies is critical for optimizing outcomes.

Keywords: Pediatric cholecystitis; Childhood obesity; Gallstones; Laparoscopic cholecystectomy; Tokyo Guidelines 2018; Hemolytic disease; Global health

Core Tip: The increase in incidence of cholecystitis in the pediatric age group parallels the global increase in childhood obesity. While the Tokyo Guidelines 2018 are widely adopted in adult surgical practice, their criteria are based on physiologic and anatomic assumptions that may not directly apply to children. This manuscript aims to contextualize pediatric acute cholecystitis as a distinct clinical entity with unique etiologies, risk factors, and outcomes. It evaluates the predictive value of obesity and hemolytic diseases and describes trends in biliary interventions such as endoscopic retrograde cholangiopancreatography.