Abstract
Background
Differentiation between patients with acute cholecystitis and patients with severe
biliary colic can be challenging. Patients with undiagnosed acute cholecystitis can
incur repeat emergency department (ED) visits, which is resource intensive.
Methods
Billing records from 2000–2013 of all adults who visited the ED in the 30 d preceding
their cholecystectomy were analyzed. Patients who were discharged from the ED and
underwent elective cholecystectomy were compared with those who were discharged and
returned to the ED within 30 d. T-tests, chi-square tests, and multivariable analysis
were used as appropriate.
Results
From 2000–2013, 3138 patients (34%) presented to the ED within 30 d before surgery,
63% were women, mean age 51 y, and of those 1625 were directly admitted from the ED
for cholecystectomy, whereas 1513 patients left the ED to return for an elective cholecystectomy.
Patients who were discharged were younger (mean age 49 versus 54 y, P < 0.001) and had shorter ED stays (5.9 versus 7.2 h, P < 0.001) than the patients admitted immediately. Of the discharged patients, 303
(20%) returned to the ED within 30 d to undergo urgent cholecystectomy. Compared with
patients with successful elective cholecystectomy after the ED visit, those who failed
the pathway were more likely to have an American Society of Anesthesiologists score
≥3 and were <40 or ≥60 compared with the successful group.
Conclusions
One in five patients failed the elective cholecystectomy pathway after ED discharge,
leading to additional patient distress and use of resources. Further risk factor assessment
may help design efficient care pathways.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Surgical ResearchAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Evidence-based current surgical practice: calculous gallbladder disease.J Gastrointest Surg. 2012; 16: 2011
- Clinical practice. Acute calculous cholecystitis.New Engl J Med. 2008; 358: 2804
- Does this patient have acute cholecystitis?.JAMA. 2003; 289: 80
- Acute cholecystitis: Schicken Sie den Patienten in den OP oder ins Bett?.MMW. 2001; 143: 28
- Does the correlation of acute cholecystitis on ultrasound and at surgery reflect a mirror image?.Am J Surg. 2004; 188: 703
- Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease.Arch Intern Med. 1994; 154: 2573
- So treffsicher ist der Ultraschall.MMW. 2000; 13: 236
- Consequences of delay in surgical treatment of biliary disease.Am J Surg. 2000; 180: 466
- Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy.Ann Surg. 2011; 254: 964
- Gallbladder perforation: risk factors and outcome.J Surg Res. 2006; 131: 204
- Early or delayed laparoscopic cholecystectomy in acute cholecystitis? Conclusions of a controlled trial.Hepatogastroenterology. 2009; 56: 11
- A population-based analysis of the clinical course of 10,304 patients with acute cholecystitis, discharged without cholecystectomy.J Trauma acute Care Surg. 2013; 74 (discussion 30–21): 26
- Improved management of acute gallstone disease after regional surgical subspecialization.World J Surg. 2008; 32: 2690
Article info
Publication history
Published online: June 18, 2014
Accepted:
June 11,
2014
Received in revised form:
May 12,
2014
Received:
January 6,
2014
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
