What happens to biliary colic patients in New York State? 10-year follow-up from emergency department visits

Altieri, Maria S.; Yang, Jie; Zhu, Chencan; Sbayi, Samer; Spaniolas, Konstantinos; Talamini, Mark A.; Pryor, Aurora D.

doi:10.1007/s00464-017-5902-5

Cited by 7 publications

(6 citation statements)

References 16 publications

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“…While efficiency and effectiveness of referral coordination varies by institution, recent data suggests that just under half of patients discharged from the ED with a diagnosis of symptomatic cholelithiasis will follow up with a surgeon. 12,13 These patients are also at high risk of subsequent re-presentations to the ED and prolonged time to OR. 13 When compared to no follow up or non-surgical physician follow up after ED presentation, evaluation by a surgical team is associated with a significantly lower risk of subsequent emergent hospitalizations.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 These patients are also at high risk of subsequent re-presentations to the ED and prolonged time to OR. 13 When compared to no follow up or non-surgical physician follow up after ED presentation, evaluation by a surgical team is associated with a significantly lower risk of subsequent emergent hospitalizations. 12 Beyond expedited surgical follow up, some findings support the stance that patients who present with symptomatic cholelithiasis in the ED should be admitted and undergo cholecystectomy within 24 hours of their initial evaluation, even if symptoms resolve and there is no evidence of cholecystitis.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Urgent or Emergent Cholecystectomy Mid-workup for Symptomatic Cholelithiasis

Dishman

Gunasingha

Hennrikus

et al. 2022

The American Surgeon

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Background Patients who undergo cholecystectomy often do so for diagnoses related to the sequelae of gallstones. Many patients present acutely, requiring urgent removal due to complications of cholelithiasis. This study aims to characterize the patient population likely to present acutely during ongoing workup for cholelithiasis to better identify those who may benefit from expedited care. Methods Medical records of all adult patients who underwent cholecystectomy for indications related to cholelithiasis between 2015 and 2016 were reviewed retrospectively. Qualitative data was analyzed using Chi square test and quantitative data was analyzed using independent t-tests. Results One hundred and seventy-four cholecystectomies were performed. Overall, 74.2% of the procedures were done electively while 25.8% were done urgently. And 42.2% of patients who underwent acute surgical intervention had evidence of prior workup. Patients requiring urgent intervention during ongoing diagnostic evaluation were more likely to have initially presented to an emergency department (ED) than another provider (68.4% vs 31.3%, P < .001) and had an odds ratio of 4.7 for undergoing acute intervention if they initially presented to the ED. They also tended to be more temporally remote from their initial diagnosis (119 ± 142 vs 74.6 ± 68.2 days, P < .19) relative to those who underwent elective operations. Discussion Patients who require urgent intervention during ongoing workup for cholelithiasis have prolonged courses of care and present to the ED more often for initial evaluation when compared to those who undergo elective intervention. These findings suggest that an emphasis on expedited workup of cholelithiasis and early surgical referral may be warranted, especially for those who initially present in the ED.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Urgent or Emergent Cholecystectomy Mid-workup for Symptomatic Cholelithiasis

Dishman

Gunasingha

Hennrikus

et al. 2022

The American Surgeon

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“…In one cohort of 71 patients in Texas, 37.1% of the patients who did not undergo early scheduled cholecystectomy following an episode of biliary colic had a repeat emergency department visit and 17.7% had two or more additional visits [ 4 ]. However, population-based data from New York state suggests that almost half of the patients with biliary colic will not return to the emergency department or have scheduled surgery within 5 years [ 5 ]. Therefore, it is unclear which biliary colic patients will have recurrent symptoms and thus benefit from a scheduled surgery.…”

Section: Introductionmentioning

confidence: 99%

Administrative codes may have limited utility in diagnosing biliary colic in emergency department visits: A validation study

Nantais

Mansour

Mestral

et al. 2022

Ann Hepatobiliary Pancreat Surg

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Backgrounds/Aims: Biliary colic is a common cause of emergency department (ED) visits; however, the natural history of the disease and thus the indications for urgent or scheduled surgery remain unclear. Limitations of previous attempts to elucidate this natural history at a population level are based on the reliance on the identification of biliary colic via administrative codes in isolation. The purpose of our study was to validate the use of International Statistical Classification of Diseases and Related Health Problems codes, 10th Revision, Canadian modification (ICD-10-CA) from ED visits in adequately differentiating patients with biliary colic from those with other biliary diagnoses such as cholecystitis or common bile duct stones. Methods: We performed a retrospective validation study using administrative data from two large academic hospitals in Toronto. We assessed all the patients presenting to the ED between January 1, 2012 and December 31, 2018, assigned ICD-10-CA codes in keeping with uncomplicated biliary colic. The codes were compared to the individually abstracted charts to assess diagnostic agreement. Results: Among the 991 patient charts abstracted, 26.5% were misclassified, corresponding to a positive predictive value of 73% (95% confidence interval 73%-74%). The most frequent reasons for inaccurate diagnoses were a lack of gallstones (49.8%) and acute cholecystitis (27.8%). Conclusions: Our findings suggest that the use of ICD-10 codes as the sole means of identifying biliary colic to the exclusion of other biliary pathologies is prone to moderate inaccuracy. Previous investigations of biliary colic utilizing administrative codes for diagnosis may therefore be prone to unforeseen bias.

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“…If urgent intervention is not performed, patients are typically discharged with a referral to a surgeon or primary care physician (PCP). However, some will experience repeat ED visits (ED revisits) for biliary-related symptoms and progression of disease while waiting for this follow-up appointment 8,9 …”

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confidence: 99%

Identifying vulnerable populations with symptomatic cholelithiasis at risk for increased health care utilization

Shenoy

Kirkland

Jackson

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Gallstones are a common problem in the United States with many patients suffering from symptomatic cholelithiasis (SC). Patients with SC may first present to the emergency department ED) and are often discharged for elective follow-up; however, it is unknown what system and patient factors are associated with increased risk for ED revisits. This study aimed to assess longitudinal ED utilization and cholecystectomy for patients with SC and identify patient, geographic, and hospital characteristics associated with ED revisits, specifically race/ethnicity and insurance status. METHODS:Patients discharged from the ED with SC between July 1, 2016, and December 31, 2017, were identified from California administrative databases and followed for 1 year. Emergency department revisits and cholecystectomy after discharge were examined using logistic regression, clustering standard errors by hospital. Models adjusted for patient, geographic, and hospital variables using census and hospital administrative data. RESULTS:Cohort included 34,427 patients who presented to the ED with SC and were discharged. There were 18.8% of the patients that had one or more biliary-related ED revisits within 1 year. In fully adjusted models, non-Hispanic Black patients had higher odds for any ED revisit (adjusted odds ratio 1.23; 95% confidence interval, 1.09-1.39) and for two more ED revisits (adjusted odds ratio 1.48; 95% confidence interval, 1.20-1.82). Insurance type was also associated with ED revisits. CONCLUSION:Non-Hispanic Black patients experienced higher utilization of health care resources for SC after adjusting for other patient, geographic and hospital variables. Strategies to mitigate these disparities may include the development of standardized protocols regarding the follow-up and education for SC. Implementation of such strategies can ensure equitable treatment for all patients.

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What happens to biliary colic patients in New York State? 10-year follow-up from emergency department visits

Abstract: A significant portion of patients (48.6%) who present to the ED with biliary colic will not return or have surgery within 5 years. A third of patients who eventually undergo cholecystectomy will go to another hospital for their surgery.

Cited by 7 publications

References 16 publications

Risk Factors for Urgent or Emergent Cholecystectomy Mid-workup for Symptomatic Cholelithiasis

Risk Factors for Urgent or Emergent Cholecystectomy Mid-workup for Symptomatic Cholelithiasis

Administrative codes may have limited utility in diagnosing biliary colic in emergency department visits: A validation study

Identifying vulnerable populations with symptomatic cholelithiasis at risk for increased health care utilization

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