Hospital readmission after emergency room visit for cholelithiasis

Taylor P. Williams, Francesca M. Dimou, Deepak Adhikari, Thomas Kimbrough, Taylor S. Riall

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8 Scopus citations

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 2 y from the date of the 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 the initial ED visit to ED readmission. Results Seventy-one patients were discharged from the ED with a diagnosis of symptomatic gallstones. Patients who had an elective cholecystectomy in the 2 y after the initial visit were 12.6%. In this group, the mean time from the initial ED visit to outpatient surgeon follow-up was 7.7 d, and all elective cholecystectomies occurred within 1 mo 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 d 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 and/or urgent cholecystectomy. Additional ED visits (43.5%) occurred within 1 mo and 60.9% within 3 mo of their initial ED visit. In patients with additional ED visits for symptomatic cholelithiasis, 60.9% had more than one abdominal ultrasound or computed tomography scan during the course of multiple visits. Conclusions 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 1-2 wk of the initial ED visit has the potential to improve outcomes for patients with symptomatic biliary colic.

Original languageEnglish (US)
Pages (from-to)318-323
Number of pages6
JournalJournal of Surgical Research
Volume197
Issue number2
DOIs
StatePublished - Aug 1 2015

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Keywords

  • Cholecystectomy
  • Cholelithiasis
  • Emergency department
  • Emergency room
  • Gallstone disease
  • Gallstones
  • Symptomatic cholelithiasis

ASJC Scopus subject areas

  • Surgery

Cite this

Williams, T. P., Dimou, F. M., Adhikari, D., Kimbrough, T., & Riall, T. S. (2015). Hospital readmission after emergency room visit for cholelithiasis. Journal of Surgical Research, 197(2), 318-323. https://doi.org/10.1016/j.jss.2015.04.032