A. Moore1, H. Carmichael1, L. Steward1, C. G. Velopulos1 1University Of Colorado Denver,Department Of Surgery,Aurora, CO, USA
Introduction:
The burden of Emergency General Surgery (EGS) leads to higher cost and less compensation to institutions. A recent study quantified the top 7 conditions contributing to 80% of the burden of EGS; cholecystectomy accounted for >150,000 cases/yr, the highest number of EGS cases that have a potentially elective course. Implications of variation in demographics and access at the local level are unclear, preventing clear strategy formation. We sought to study this more specifically in our population. We hypothesized that our cholecystectomy patient pool would have unique characteristics informing healthcare access in our area.
Methods:
We identified cholecystectomy patients at our academic hospital over a 6-month period from January to June of 2018 and classified them as emergent or elective. We excluded pregnant patients, patients <18, and patients who had undergone another major procedure concurrently. Cases that initially presented emergently, with interval elective surgery were also excluded from the study. We abstracted patient demographics and clinical course from the EMR.
Results:
Of 289 patients who underwent cholecystectomy, 267 met inclusion criteria. There were no differences in age, sex or BMI between the two groups. Most patients (n=196, 73.4%) had surgery emergently. Emergent patients were more likely to be minorities (65.8% vs. 40.8%, p < 0.001), less likely to have insurance or a primary care physician, and notably 25% of them required an interpreter (see Table). While patients in the elective setting had higher prevalence of chronic symptoms (more than one-month duration), many patients in the emergent setting had duration of symptoms of months to years (n=107 patients, 56.3%). Most patients in the emergent group had acute cholecystitis (n=94, 48%), choledocholithiasis (n=27, 14%) or pancreatitis (13.3%). Elective patients most commonly had symptomatic cholelithiasis (n=43, 61%). Emergent patients had a longer length of stay (2 vs. 0 days, p<0.001). Overall, rates of conversion to an open procedure or other complication were low, without significant differences in emergent versus elective (7.1% vs. 4.2%, p=0.56).
Conclusion:
Significant differences in insurance status and utilizing primary care in our EGS population compared to elective patients indicates several targets for gallbladder disease at our institution. There was also a trend towards increased use of interpreters in this population. The majority of patients in the emergent group experienced chronic symptoms, indicating an opportunity to prevent the necessity of emergency surgery as treatment. This study provides local population characterization for improvements in access to care which can lead to decreases in emergency gallbladder.
