S. Warner1, A. Carleo2, J. Patel2, S.L. Tannenbaum1, R. Kessler2, G. Lehr1 1Broward Health Medical Center, Surgery Department, Fort Lauderdale, FL, USA 2Nova Southeastern University Dr. Kiran C. Patel School of Osteopathic Medicine, Medical School, Fort Lauderdale, FL, USA
Introduction:
Gallstone disease affects 10-15% of the American population and results in 500,000 cholecystectomies annually. Advances in laparoscopic surgery have improved patient outcomes, but there remains room for improvement in the diagnostic process for acute cholecystitis. Popular imaging modalities are gallbladder ultrasounds (US) and hepatobiliary nuclear medicine studies (HIDA scans). US combined with physical exam has similar accuracy to HIDA scans based on Tokyo Guidelines. Our aim was to evaluate the utilization and effects of HIDA scans. Our hypothesis is that HIDA scans contribute to increased length of stay (LOS) and time to surgery (TTS) compared to US alone.
Methods:
A retrospective cohort study included patients admitted to a community hospital with gallbladder disease between January 1st, 2019, and December 31st, 2020. Patients were 18 years or older and underwent US gallbladder during admission. Exclusion criteria included patients who did not undergo a cholecystectomy, those undergoing elective cholecystectomy or patients with HIDA scans performed postoperatively. A total of 1,000 patients met the inclusion criteria, with a random sample of 260 reviewed resulting in 159 patients after exclusions. The primary outcomes were HIDA scans performed, hospital LOS and TTS. Secondary outcomes included percentage of HIDA scans performed on patients meeting criteria for acute cholecystitis based on Tokyo Guidelines. Continuous variables were compared using Mann-Whitney tests.
Results:
Our analysis demonstrated that patients who underwent HIDA scans experienced longer TTS and LOS compared to those who only had ultrasounds. However, only the TTS was statistically significant (2.25 days no HIDA compared to 2.85 days with HIDA, p=0.039). Excluding patients with complications of cholecystitis such as gallstone pancreatitis and choledocholithiasis, the TTS remained significant (1.30 days no HIDA compared to 2.48 days with HIDA, p=0.007). Of patients who had definite cholecystitis based on US and Tokyo guidelines, 48.5% underwent a HIDA scan.
Conclusion:
Our findings support the hypothesis that HIDA scans contribute to increased TTS by more than 24 hours when HIDA scans are used. There are major implications of delaying cholecystectomy by a day with increased morbidity and mortality. Additionally, almost half of patients diagnosed by US findings also underwent a HIDA scan. While HIDA scans provide valuable diagnostic information, their routine use in cases where US and clinical criteria highly suggest cholecystitis is unnecessary and potentially harmful to patient care. This study highlights the need for a selective approach to HIDA scans, reserving for cases of diagnostic uncertainty after initial imaging and clinical evaluation. Future studies should be used to further evaluate the impact of HIDA scans on patient outcomes and to redefine diagnostic pathways in acute cholecystitis.