Success of elective cholecystectomy treatment plans after emergency department visit

Abstract

Introduction 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 days preceding their cholecystectomy were analyzed. Patients who were discharged from the ED and underwent elective cholecystectomy were compared to those who were discharged and returned to the ED within 30 days. T-tests, chi-square tests and multivariable analysis were utilized as appropriate. Results From 2000 - 2013, 3138 patients (34%) presented to the ED within 30 days prior to surgery, 63% were women, mean age 51 years, and of those 1625 were directly admitted from the ED for cholecystectomy while 1513 patients left the ED to return for an elective cholecystectomy. Patients who were discharged were younger (mean age 49 vs 54 yrs, p<0.001) and had shorter ED stays (5.9 vs 7.2 hrs, p<0.001) than the patients admitted immediately. Of the discharged patients, 303 (20%) returned to the ED within 30 days to undergo urgent cholecystectomy. Compared to patients with successful elective cholecystectomy after the ED visit, those who failed the pathway were more likely to have an ASA score > 3 and were <40 or ≥60 compared to 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.

Emergency presentations of acute biliary pain: changing patterns of management in a tertiary institute

“…A study of unplanned readmissions for biliary complications whilst on a waiting list for laparoscopic cholecystectomy estimated the overall cost to be approximately AU$6129 (excluding ED costs and investigations), compared with AU$3725 for elective admissions. 28 It must be acknowledged that not all patients are suitable for early laparoscopic surgery. 27 Data from the United States show that patients presenting to ED with acute biliary pain and then discharged on a pathway for elective cholecystectomy have a 20% chance of representing within 30 days.…”

“…What is also not captured is the rate of presentations to general practitioners with biliary type pain and the time and resources lost to the community by these visits. 28 It must be acknowledged that not all patients are suitable for early laparoscopic surgery. Patient factors may necessitate the postponement of surgery, such as age, medical co-morbidities and the presence of anticoagulation.…”

Hospital readmission after emergency room visit for cholelithiasis

“…Furthermore, operative times and hospital stays were increased in these patients compared to patients who underwent surgical intervention within 24 hours. 3 Bingener and colleagues 11 conducted a retrospective cohort of patients who presented to the ED with cholelithiasis and outcomes of those who underwent planned cholecystectomy versus those who did not. Patients discharged from the ED were more likely to be younger and with a lower leukocyte count; 20% returned to the ED within 30 days and underwent an urgent cholecystectomy, with half presenting within 7 days.…”

Comparison of the Intensity of Pain in Patients with Acute Cholecystitis with Different Types of Surgical Accesses

“…There are different options for surgical approaches for cholecystectomy. Cholecystectomy is performed by a laparotomy approach, which has lost its popularity today due to the appearance of postoperative complications (e. g., infectious complications from a surgical wound) in the recovery period, but it is performed when patient has contraindications for laparoscopy (Abelson et al, 2015;Bingener et al, 2015;Jones et al, 2021;Singh et al, 2020). There are also laparoscopic cholecystectomy and cholecystectomy performed in the way of a mini-laparotomy in the right hypochondrium (Del-Moral-Martínez et al, 2015;Jung et al, 2019;Qiu et al, 2019).…”