MSSP773: GALLBLADDER CALLS THE S.H.O.T.S
Kelly Tang; Rhett Rainey; Navtej Grewal; Colin Brown; William Beaumont Army Medical Center
Objectives: In the United States, on average, a little over 300,000 patients present to the Emergency Department (ED) for symptomatic cholelithiasis annually. There have been a handful of studies published between 2015 to 2023 looking at data in a handful of states, Canada, United Kingdom, and Australia analyzing costs and clinical outcomes. A study done in Canada demonstrated ED physician point of care biliary ultrasound is associated with shorter ED visits. A collaborated quality improvement study between the Emergency Medicine Department and Surgery Department conducted in Banner-University of Arizona demonstrated improve workflow, such as shorter ED length of stay and reduced hospital length of stay. Whether these presentations resulted in a General Surgery consult or referral, repeat ED visits or subsequent development of biliary disease complication have not been extensively studied. What has been studied regarding cost analysis wise, a study in Washington DC demonstrated patients who do not receive a cholecystectomy at their initial visit was associated with increased costs.
Methods: This is a retrospective observational study using electronic medical records (EMR) to look at laparoscopic cholecystectomies performed at this institution. Data was collected by first obtaining all cholecystectomies performed followed by chart review and variable extractions. The variables investigated include date of surgery, number of emergency room visits for the same chief complaint of abdominal pain, ultrasound findings, lab findings, and physical exam findings.
Inclusion criteria are all patients who have had a cholecystectomy performed at WBAMC since transition to MHS genesis with exclusion criteria being pregnant patients.
Statistics and trend will be analyzed of variables of interest of initial presentation to ultimately the time frame to surgery. How often is general surgery consulted in-house versus outpatient referral.
Results: Out of 336 patients, 27 patients had at least 2 ED visits prior to their cholecystectomy. The greatest number of ED visits was 4 and was seen with 2 patients. A spearman’s Rho correlation was performed which demonstrated no correlation between the number of ED visits and findings of cholecystitis. Of the different variables assessed transaminitis was the most prevalent findings among all patients.
Conclusion: Although there is no correlation between the number of ED visits & cholecystitis; our patients should not be visiting the ED with the same chief complaints upward to 4 times. There are many variables that are statistically significant to result in a consult or referral placed.