Cioffi, Stefano Piero BernardoSpota, AndreaVirdis, FrancescoAltomare, MicheleMingoli, AndreaCimbanassi, StefaniaNava, Francesca LauraNardi, SilvanaDi Martino, MarcelloDi Saverio, SalomoneIelpo, BenedettoPata, FrancescoPellino, GianlucaSartelli, MassimoDamaskos, DimitriosCoccolini, FedericoPisanu, AdolfoCatena, FaustoPodda, MauroMANCTRA-1 study group2025-11-122025-11-122025Cioffi SPB, Spota A, Virdis F, Altomare M, Mingoli A, Cimbanassi S, Nava FL, Nardi S, Di Martino M, Di Saverio S, Ielpo B, Pata F, Pellino G, Sartelli M, Damaskos D, Coccolini F, Pisanu A, Catena F, Podda M; MANCTRA-1 study group. Mild acute biliary pancreatitis: still a surgical disease. A post-hoc analysis of the MANCTRA-1 international study. Eur J Trauma Emerg Surg. 2025 Jan 17;51(1):24. DOI: 10.1007/s00068-024-02748-91863-9933http://hdl.handle.net/10230/71871Background: The 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. Methods: We 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. Results: Between 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. Conclusion: Our 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.application/pdfeng© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.info:eu-repo/semantics/article2025-11-12http://dx.doi.org/10.1007/s00068-024-02748-9Acute biliary pancreatitisEarly cholecystectomyGuidelinesMildReadmissionRecurrenceinfo:eu-repo/semantics/openAccess