Cholecystectomy (CCY) is generally advocated for patients presenting with acute cholangitis (AC) to ensure definitive management and prevent recurrence. The optimal timing for cholecystectomy (CCY), however, remains to be determined. This study aims to comprehend the clinical outcomes and financial implications of performing a CCY during index admission.

We conducted a retrospective cohort study using data from the Nationwide Readmission Database (2016–2020). Adult patients admitted with a diagnosis of AC were categorized based on whether CCY was performed during index admission and were further stratified by severity per the Tokyo Guidelines. Mortality, resource utilization, and readmission rates were analyzed using a multivariate Cox regression model. STATA 14.2 was utilized for statistical analysis.

Of 29,241 adult patients with AC, 4319 (14.77 %) underwent CCY during the index admission. Patients with index admission CCY had lower comorbidity index and AC severity compared to those without index admission CCY (P < 0.01). Significantly lower in-hospital mortality (adjusted hazard ratio (aHR) 0.40, P < 0.01), 30-day and 90-day readmission rates (aHR 0.49 and 0.48 respectively, P < 0.01) were observed for the index CCY group. Reduced mortality and improved readmission rates were persistent on subgroup analysis for severe and non-severe cholangitis patients.

Our findings advocate the effectiveness of index admission CCY in lowering mortality and readmission rates, irrespective of AC severity. These findings highlight the need for future prospective studies and updated guidelines on surgical intervention in AC management.