B. F. Goldberg1, K. M. Mueck1, H. M. Starkey-Smith1, C. C. Wan1, J. P. Hasapes1, T. C. Ko1, L. S. Kao1 1University Of Texas Health Science Center At Houston,General Surgery,Houston, TX, USA
Introduction: Benign biliary disease accounts for a disproportionate amount of recurrent emergency department (ED) visits and readmissions. It is unknown what factors present at ED consultation predict subsequent readmission with more severe disease such as acute cholecystitis, choledocholithiasis, gallstone pancreatitis, or ascending cholangitis. The aim of this study was to determine if there are patient or radiologic factors which predict recurrent ED visits, readmission with complicated biliary disease, and worse outcomes.
Methods: This was a retrospective cohort study of all patients presenting to a single safety-net hospital ED June 2014-2016 who received an abdominal ultrasound (US) for benign biliary disease. Demographic, admission, and outcome data were recorded. Univariate and logistic regression analyses were performed to identify factors associated with readmission with complicated biliary disease.
Results: Of 288 patients, 189 (66%) were admitted for surgery, and 99 (34%) were discharged. Of those discharged, 71 (72%) were not evaluated by a surgeon at index ED visit. There was no difference in age, gender, race/ethnicity, language, or ASA score between the groups. Discharged patients were more likely to have diabetes (10% vs 19%, p=0.03), heart disease (3% vs 10%, p=0.01), cancer (1% vs 6%, p=0.02), or chronic liver disease (3% vs 9%, p=0.02). 15 (15%) patients underwent elective outpatient cholecystectomy, and 15 (15%) were readmitted with complicated biliary disease. There was no difference in age, gender, race/ethnicity, language preference, ASA score, or comorbidities between the readmitted and non-readmitted groups. Readmitted patients had more prior ED visits (p=0.02) and hospitalizations (p<0.01). They were more likely to have an impacted stone (40% vs 0%, p=0.02), or a stone in the gallbladder neck (p<0.01). Rates of postoperative complications, reoperation, and conversion to open were similar between patients undergoing elective versus urgent surgery, while postoperative readmission rate was higher in the latter group (31% vs 7%, p=0.02).
Conclusion: Patients with comorbidities, with sonographic findings of complicated biliary disease, and without surgical consultation were more likely to be readmitted after discharge from the emergency department. Further study is necessary to determine what factors contributed to discharge and to assess whether admission on index presentation would have resulted in improved outcomes.