• Stefano Piero Bernardo Cioffi, Andrea Spota, Francesco Virdis, Michele Altomare, Andrea Mingoli, Stefania Cimbanassi, Francesca Laura Nava, Silvana Nardi, Marcello Di Martino, Salomone Di Saverio, Benedetto Ielpo, Francesco Pata, Gianluca Pellino, Massimo Sartelli, Dimitris Damaskos, Federico Coccolini, Adolfo Pisanu, Fausto Catena, Mauro Podda, and MANCTRA-1 study group.
• General Surgery Trauma Team, Niguarda Hospital, Piazzale Dell'ospedale Maggiore 3, 20162, Milan, Italy. Stefanopiero.cioffi@uniroma1.it.
• Eur J Trauma Emerg Surg. 2025 Jan 17; 51 (1): 2424.

BackgroundThe current standard of care for mild acute biliary pancreatitis (MABP) involves early laparoscopic cholecystectomy (ELC) to reduce the risk of recurrence. The MANCTRA-1 project revealed a knowledge-to-action gap and higher recurrence rates in patients admitted to medical wards, attributable to fewer ELCs being performed. The project estimated a 35% to 70% probability of narrowing this gap by 2025. This study evaluates the safety of suboptimal ELC implementation and identifies risk factors for recurrent acute biliary pancreatitis (RAP) in patients not undergoing ELC after an MABP episode.MethodsWe conducted a post-hoc analysis of the MANCTRA-1 registry, including MABP patients who did not undergo ELC during the index hospitalization, excluding those with related complications. The primary outcome was the 30-day hospital readmission rate due to RAP. We performed multivariable logistic regression to find risk factors associated with the primary outcome.ResultsBetween January 2019 and December 2020, 1920, MABP patients from 150 centers were included in the study. The 30-day readmission rate due to RAP was 6%. Multivariable logistic regression found the admission to a medical ward (internal medicine or gastroenterology) (OR = 1.95, p = 0.001) and a positive COVID-19 test (OR = 3.08, p = 0.029) as independent risk factors for RAP.ConclusionOur analysis offers valuable insights into the management of MABP, particularly in centers where ELC cannot be fully implemented due to logistical and clinical constraints, worsened by the COVID-19 pandemic. Regardless of the admitting ward, prompt access to surgical care is crucial in reducing the risk of early recurrence, highlighting the need to implement surgical consultation pathways within MABP care bundles.© 2025. The Author(s).

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