Trends in Follow-Up of Patients Presenting to the Emergency Department with Symptomatic Cholelithiasis

Francesca M. Dimou, Deepak Adhikari, Hemalkumar Mehta, Taylor S. Riall

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background Fewer than 25% of Medicare beneficiaries presenting with symptomatic cholelithiasis undergo elective cholecystectomy. To better understand underuse of cholecystectomy, we examined physician follow-up patterns after emergency department (ED) visits for symptomatic gallstones. Study Design We used 100% Texas Medicare claims (2001 to 2010) to identify patients 66 years of age and older who presented to the ED with symptomatic cholelithiasis and were discharged home without cholecystectomy. Timing of outpatient physician visits after ED discharge and rates of emergent cholecystectomy based on physician follow-up patterns were compared. Results In total, 11,126 patients presented to the ED with symptomatic cholelithiasis and were discharged without cholecystectomy. After discharge, 5,327 patients (47.9%) had an outpatient surgeon visit, 29.0% saw another physician and never saw a surgeon, and 23.1% never saw a physician; 68.2% of patients who saw a surgeon underwent elective cholecystectomy; and 8.3% of patients who saw a surgeon, 14.6% of patients who saw other physicians and no surgeon, and 77.6% of patients who never saw any physician, required emergent hospitalization (p <0.0001). For people who did not see a physician, mean time to emergent hospitalization was 7.5 days (median 2 days); 95.9% presented within 2 weeks after their initial presentation. Conclusions Fewer than half of patients were evaluated by a surgeon after an initial ED visit for symptomatic gallstones. Patients who did not have physician follow-up were most likely to require emergent cholecystectomy, suggesting inappropriate ED discharge and highlighting the need for timely follow-up. Early outpatient surgical consultation is critical in determining appropriateness for cholecystectomy and avoiding emergent cholecystectomy in older patients with symptomatic gallstones.

Original languageEnglish (US)
Pages (from-to)377-384
Number of pages8
JournalJournal of the American College of Surgeons
Volume222
Issue number4
DOIs
StatePublished - Apr 1 2016

Fingerprint

Cholelithiasis
Cholecystectomy
Hospital Emergency Service
Physicians
Gallstones
Outpatients
Medicare
Hospitalization
Surgeons
Referral and Consultation

ASJC Scopus subject areas

  • Surgery

Cite this

Trends in Follow-Up of Patients Presenting to the Emergency Department with Symptomatic Cholelithiasis. / Dimou, Francesca M.; Adhikari, Deepak; Mehta, Hemalkumar; Riall, Taylor S.

In: Journal of the American College of Surgeons, Vol. 222, No. 4, 01.04.2016, p. 377-384.

Research output: Contribution to journalArticle

Dimou, Francesca M. ; Adhikari, Deepak ; Mehta, Hemalkumar ; Riall, Taylor S. / Trends in Follow-Up of Patients Presenting to the Emergency Department with Symptomatic Cholelithiasis. In: Journal of the American College of Surgeons. 2016 ; Vol. 222, No. 4. pp. 377-384.
@article{4ecbe3188bcb4d1b92345e1607baa6d5,
title = "Trends in Follow-Up of Patients Presenting to the Emergency Department with Symptomatic Cholelithiasis",
abstract = "Background Fewer than 25{\%} of Medicare beneficiaries presenting with symptomatic cholelithiasis undergo elective cholecystectomy. To better understand underuse of cholecystectomy, we examined physician follow-up patterns after emergency department (ED) visits for symptomatic gallstones. Study Design We used 100{\%} Texas Medicare claims (2001 to 2010) to identify patients 66 years of age and older who presented to the ED with symptomatic cholelithiasis and were discharged home without cholecystectomy. Timing of outpatient physician visits after ED discharge and rates of emergent cholecystectomy based on physician follow-up patterns were compared. Results In total, 11,126 patients presented to the ED with symptomatic cholelithiasis and were discharged without cholecystectomy. After discharge, 5,327 patients (47.9{\%}) had an outpatient surgeon visit, 29.0{\%} saw another physician and never saw a surgeon, and 23.1{\%} never saw a physician; 68.2{\%} of patients who saw a surgeon underwent elective cholecystectomy; and 8.3{\%} of patients who saw a surgeon, 14.6{\%} of patients who saw other physicians and no surgeon, and 77.6{\%} of patients who never saw any physician, required emergent hospitalization (p <0.0001). For people who did not see a physician, mean time to emergent hospitalization was 7.5 days (median 2 days); 95.9{\%} presented within 2 weeks after their initial presentation. Conclusions Fewer than half of patients were evaluated by a surgeon after an initial ED visit for symptomatic gallstones. Patients who did not have physician follow-up were most likely to require emergent cholecystectomy, suggesting inappropriate ED discharge and highlighting the need for timely follow-up. Early outpatient surgical consultation is critical in determining appropriateness for cholecystectomy and avoiding emergent cholecystectomy in older patients with symptomatic gallstones.",
author = "Dimou, {Francesca M.} and Deepak Adhikari and Hemalkumar Mehta and Riall, {Taylor S.}",
year = "2016",
month = "4",
day = "1",
doi = "10.1016/j.jamcollsurg.2015.12.011",
language = "English (US)",
volume = "222",
pages = "377--384",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Trends in Follow-Up of Patients Presenting to the Emergency Department with Symptomatic Cholelithiasis

AU - Dimou, Francesca M.

AU - Adhikari, Deepak

AU - Mehta, Hemalkumar

AU - Riall, Taylor S.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background Fewer than 25% of Medicare beneficiaries presenting with symptomatic cholelithiasis undergo elective cholecystectomy. To better understand underuse of cholecystectomy, we examined physician follow-up patterns after emergency department (ED) visits for symptomatic gallstones. Study Design We used 100% Texas Medicare claims (2001 to 2010) to identify patients 66 years of age and older who presented to the ED with symptomatic cholelithiasis and were discharged home without cholecystectomy. Timing of outpatient physician visits after ED discharge and rates of emergent cholecystectomy based on physician follow-up patterns were compared. Results In total, 11,126 patients presented to the ED with symptomatic cholelithiasis and were discharged without cholecystectomy. After discharge, 5,327 patients (47.9%) had an outpatient surgeon visit, 29.0% saw another physician and never saw a surgeon, and 23.1% never saw a physician; 68.2% of patients who saw a surgeon underwent elective cholecystectomy; and 8.3% of patients who saw a surgeon, 14.6% of patients who saw other physicians and no surgeon, and 77.6% of patients who never saw any physician, required emergent hospitalization (p <0.0001). For people who did not see a physician, mean time to emergent hospitalization was 7.5 days (median 2 days); 95.9% presented within 2 weeks after their initial presentation. Conclusions Fewer than half of patients were evaluated by a surgeon after an initial ED visit for symptomatic gallstones. Patients who did not have physician follow-up were most likely to require emergent cholecystectomy, suggesting inappropriate ED discharge and highlighting the need for timely follow-up. Early outpatient surgical consultation is critical in determining appropriateness for cholecystectomy and avoiding emergent cholecystectomy in older patients with symptomatic gallstones.

AB - Background Fewer than 25% of Medicare beneficiaries presenting with symptomatic cholelithiasis undergo elective cholecystectomy. To better understand underuse of cholecystectomy, we examined physician follow-up patterns after emergency department (ED) visits for symptomatic gallstones. Study Design We used 100% Texas Medicare claims (2001 to 2010) to identify patients 66 years of age and older who presented to the ED with symptomatic cholelithiasis and were discharged home without cholecystectomy. Timing of outpatient physician visits after ED discharge and rates of emergent cholecystectomy based on physician follow-up patterns were compared. Results In total, 11,126 patients presented to the ED with symptomatic cholelithiasis and were discharged without cholecystectomy. After discharge, 5,327 patients (47.9%) had an outpatient surgeon visit, 29.0% saw another physician and never saw a surgeon, and 23.1% never saw a physician; 68.2% of patients who saw a surgeon underwent elective cholecystectomy; and 8.3% of patients who saw a surgeon, 14.6% of patients who saw other physicians and no surgeon, and 77.6% of patients who never saw any physician, required emergent hospitalization (p <0.0001). For people who did not see a physician, mean time to emergent hospitalization was 7.5 days (median 2 days); 95.9% presented within 2 weeks after their initial presentation. Conclusions Fewer than half of patients were evaluated by a surgeon after an initial ED visit for symptomatic gallstones. Patients who did not have physician follow-up were most likely to require emergent cholecystectomy, suggesting inappropriate ED discharge and highlighting the need for timely follow-up. Early outpatient surgical consultation is critical in determining appropriateness for cholecystectomy and avoiding emergent cholecystectomy in older patients with symptomatic gallstones.

UR - http://www.scopus.com/inward/record.url?scp=84961770716&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84961770716&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2015.12.011

DO - 10.1016/j.jamcollsurg.2015.12.011

M3 - Article

C2 - 26837281

AN - SCOPUS:84961770716

VL - 222

SP - 377

EP - 384

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 4

ER -