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Background: Only about 50% of acute gallstone pancreatitis admissions undergo index cholecystectomy.Aims: We aimed to analyze the national trends in acute gallstone pancreatitis management: the proportion and optimal timing of cholecystectomy. Methods: Adult admissions with acute gallstone pancreatitis and associated procedures were extracted from National Inpatient Sample (2005-2014yy). Patients with index cholecystectomy were identified and divided into early and delayed intervention groups. Trends, complications, mortality, and hospital resource utilization were analyzed. Results: In 991,476 acute gallstone pancreatitis hospitalizations, the rate of index cholecystectomy remained low at 53-55%. Analysis of cholecystectomy complications and resource utilization demonstrated the safest and most cost-effective strategy is to perform cholecystectomy during 24-72 hours of admission. A risk difference of 12.6% in the complication rate was observed between early (72hrs) cholecystectomy groups. Delay in cholecystectomy to day five or beyond was associated with significantly higher morbidity, mortality, and resource utilization. Conclusion: The rate of index cholecystectomies to prevent recurrent acute gallstone pancreatitis remains significantly low nationally (53-55%). Our analysis demonstrates that cholecystectomy should be avoided in the first 24 hours, and optimal timing for intervention is from 24 to 72 hours of acute gallstone pancreatitis hospitalization. Careful patient selection and timing of definitive operative management are important to ensure the best clinical outcomes and avoid unnecessary healthcare expenses.