Hospital readmission after emergency room visit for cholelithiasis

Abstract

Background For patients presenting with symptomatic cholelithiasis, cholecystectomy is the definitive treatment modality. Our goal was to evaluate the surgical follow-up and outcomes in patients seen in the Emergency Department (ED) for an episode of symptomatic cholelithiasis and discharged home for elective follow-up. Methods We performed a retrospective review of consecutive patients seen in the ED for cholelithiasis and discharged without hospital admission between August 2009 and May 2014. All patients were followed for two years from the date of initial ED visit. We evaluated outpatient surgeon visits, elective and emergent cholecystectomy rates, and additional ED visits. Cumulative incidence and Kaplan-Meier curves were used to examine the time from the initial ED visit to outpatient surgeon evaluation and the time from initial ED visit to ED readmission. Results Seventy-one patients were discharged from the ED with a diagnosis of symptomatic gallstones. 12.6% of patients had an elective cholecystectomy in the two years after the initial visit. In this group, the mean time from the initial ED visit to outpatient surgeon follow-up was 7.7 days and all elective cholecystectomies occurred within one month of the initial visit. Of the 62 patients who did not have an elective cholecystectomy, only 14.5% of patients in this group had outpatient surgeon follow-up at mean time of 137 days from the initial ED visit for symptomatic gallstones. In addition, 37.1% of patients in this group had additional ED visits for gallstone-related symptoms, with 17.7 % of patients having two or more additional ED visits, and 12.9% required emergent/urgent cholecystectomy. 43.5% of additional ED visits occurred within one month and 60.9% within three months of their initial ED visit. In patients with additional ED visits for symptomatic cholelithiasis, 60.9% had more than one abdominal Ultrasound (US) or Computed Tomography (CT) scan during the course of multiple visits. Conclusion Failure to achieve a timely surgical follow-up leads to multiple ED readmissions and emergent gallstone related hospitalizations, including emergency cholecystectomy. System-level interventions to ensure outpatient surgical follow-up within one to two weeks of the initial ED visit has the potential to improve outcomes for patients with symptomatic biliary colic.

Population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

“…Delayed cholecystectomy can result in emergency readmissions and poorer outcomes. Logistical barriers to emergency cholecystectomy, such as lack of prompt access to specialist investigations and emergency theatre availability, appear to explain differences in service provision.…”

Factors associated with emergency department visit within 30 days after discharge

“…Aside from readmission, emergency department (ED) utilization is another adverse event after discharge, representing patient’s instability after discharge [ 7 , 9 – 11 ]. There is a high proportion of hospitalization after ED visit, leading to higher costs [ 12 – 14 ].…”

“Analysis of readmissions to the emergency department among patients presenting with abdominal pain”

“…It may be explained by recurrent symptoms, which are often observed by patients who have recently experience biliary colic symptoms [27]. Williams et al showed that failure to achieve a timely surgical follow-up in this group of patients may result in multiple ED readmissions and emergent gallstone-related hospitalizations [28]. Appendicitis, which was the second most common final diagnosis during subsequent visits was the reason for readmission of three patients.…”