Same-Day versus Conventional Different-Day Endoscopic Retrograde Cholangiopancreatography and Laparoscopic Cholecystectomy: A Multi-Center Retrospective Study MOHAMMED H. AL-TEMIMI, M.D., M.P.H.,*† CHARLES TRUJILLO, M.D.,*† MITAL SHAH, B.S.,‡ SRIRAM RANGARAJAN, M.D.,*† EDWIN KIM, M.D.,*† BINDUPRYIA CHANDRASEKARAN, M.D.,*† DAVID HANDMAN, M.D.,* SAMIR JOHNA, M.D.*† From the *Kaiser Permanente Fontana Medical Center, Fontana, California; †Arrowhead Regional Medical Center, Colton, California; and ‡College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California Same-day endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy (LC) could potentially reduce hospital length of stay (HLOS). Patients undergoing same-day pro- cedures (N 5 164) between 2012 and 2014 were compared with different-day procedures per- formed in the second half of 2014 (N 5 276), in the Kaiser Permanente Southern California database. Both groups had comparable baseline characteristics. ERCP success rate (97.5% vs 93.5%), overall postoperative morbidity (3.66% vs 3.99%), and retained stones (2.5% vs 5.8%) were not different between groups (P > 0.05); however, HLOS was shorter in the same-day group (2.99 6 2.34 vs 3.84 6 2.52 days, P < 0.001). Morbidity, procedure success, and HLOS were not different in the same-day group, whether ERCP was performed before or after LC (P > 0.05). In the same-day group, those undergoing single anesthesia had higher BMI (40.1 6 10.8 vs 30.3 6 6.6) and were more likely to have gastric bypass (30% vs 0%) than those undergoing separate anesthesia sessions (P < 0.01). Longer HLOS (4.8 6 3.5 vs 2.9 6 2.2 days) and higher estimated blood loss (65 6 90 mL vs 20 6 29 mL) were also associated with the single-anesthetic session (P < 0.01). ERCP performed on the same day of LC reduces HLOS without increasing morbidity. This approach does not affect postoperative morbidity and ERCP success rate, whether ERCP was performed before or after LC. A BOUT 2 TO 5 per cent of patients with gallbladder disease will also have common bile duct (CBD) stones that require further treatments. 1 Open and lap- aroscopic CBD exploration, as well as, preoperative, intraoperative, and postoperative endoscopic retro- grade cholangiopancreatography (ERCP) are potential procedures to manage CBD stones, but ERCP is by far the most commonly used in the United States. 2 Traditionally, ERCP and cholecystectomy (LC) are performed as two sequential procedures on two sepa- rate days. 2 This approach is associated with longer hospital stay and the need for multiple anesthetics. Recently, there have been reports about the safety and feasibility of performing ERCP and LC on the same day and under a single anesthesia session. 3–5 Wild et al. reviewed their experience with performing both procedures under a single general anesthesia event between 2010 and 2014. They found that same-day, single anesthesia ERCP and LC decreased hospital length of stay (HLOS) by two days on average and $12,000 in cost saving. 4 Similarly, Mallick et al. reviewed their experience with performing 33 pro- cedures of same-day, same anesthesia ERCP and LC between 2011 and 2014 and found that this approach is safe, effective, and economically viable. 3 Although this approach seems to be ideal, it is associated with longer operative time and the need for appropriate logistics to facilitate its performance. 6 It has also been demonstrated that ERCP within 24 hours of LC is safe and could reduce length of stay without increasing operative time or postoperative mor- bidity. 7 Very few studies reported the outcomes of se- quential (different anesthesia session) same-day ERCP Presented at the Southern California Chapter of the American College of Surgeons annual meeting, January 19–21, 2018, Santa Barbara, CA. Address correspondence and reprint requests to Mohammed Al-Temimi, M.D., M.P.H., Arrowhead Regional Medical Center/ Kaiser Permanente (Fontana), 9961 Sierra Avenue, Fontana, CA 92335. E-mail: muhammidh.hussein@yahoo.com. 1679