Timing of cholecystectomy after acute biliary pancreatitis: Impact of disease severity and biological sex.

BACKGROUND: Optimal timing of cholecystectomy after acute biliary pancreatitis (abP) remains debated. While early surgery is recommended for mild abP, guidance for more severe disease is less well defined, and outcome heterogeneity suggests clinically relevant modifiers. AIMS: To assess the impact of surgical timing, disease severity, and sex on outcomes after cholecystectomy following abP. METHODS: This single-center retrospective cohort study included 205 patients undergoing cholecystectomy after abP. Outcomes were compared between early one-stage (during index admission) and interval two-stage cholecystectomy, stratified by abP severity and sex. RESULTS: Overall morbidity did not differ between one-stage and two-stage cholecystectomy. However, one-stage surgery was associated with higher postoperative inflammatory response, need for intensive care, and longer hospitalization. In mild abP, males underwent more complex cholecystectomies, with longer operative time, increased blood loss, higher conversion rates, and more frequent intensive care. In moderate/severe abP, outcomes were largely comparable between sexes, except for prolonged intensive care need and a trend toward longer hospitalization in women after one-stage cholecystectomy. CONCLUSION: Post-cholecystectomy outcomes after abP depend on the interaction between disease severity, surgical timing, and sex. While early cholecystectomy appears safe in mild abP, sex-specific vulnerabilities and resource utilization should be considered supporting tailored timing strategies.