• Urgent ERCP (within 24 hours) significantly reduced in-hospital mortality to 0.5% compared to 21% for non-urgent (adjusted OR 0.09; p=0.024).
• Median hospital stay was shorter with urgent ERCP (5 days vs 8 days; p<0.001).

Surgeons should prioritize early ERCP for moderate to severe cases to improve outcomes.

• Mortality benefits were pronounced in moderate and severe cholangitis but absent in mild cases.