T. P. Williams1, D. Adhikari1, J. E. Bargerstock1, T. D. Kimbrough1, T. S. Riall1 1University Of Texas Medical Branch,Department Of Surgery,Galveston, TX, USA
Introduction: 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 six months 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. 11.3% of patients had an elective cholecystectomy in the six months after the initial visit. In this group, the mean time from the initial ED visit to outpatient surgeon follow-up was 7.9 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 11.3% of patients in this group had outpatient surgeon follow-up at mean time of 39.7 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 14.5% 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.