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Cholecystectomy: Exploring the Interplay Between Access to Care and Emergent Presentation
Allison N Moore1, Heather Carmichael2, Lauren Steward2
1Department of Surgery, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado.
The Journal of Surgical Research
|July 20, 2019
Summary
Many patients undergo emergency gallbladder surgery despite having chronic symptoms, highlighting opportunities to improve access to elective care. Addressing insurance and primary care access can reduce emergent cases.
Area of Science:
- General Surgery
- Health Services Research
Background:
- Emergency general surgery incurs high costs and low institutional reimbursement.
- Cholecystectomy represents over 150,000 annual cases, with many having a potentially elective course.
Purpose of the Study:
- To characterize the patient pool undergoing cholecystectomy to understand healthcare access issues.
- To identify factors contributing to emergent versus elective cholecystectomy presentations.
Main Methods:
- Retrospective review of cholecystectomy patients (January-June 2018) at an academic hospital.
- Classification of patients into emergent or elective groups, excluding pregnant and underage patients.
- Abstraction of demographic and clinical data from medical records.
Main Results:
- Most of the 267 included patients (73.4%) presented emergently.
- Emergent patients were more likely to be minorities, uninsured, lack a primary care physician, and require an interpreter.
- Insurance status, lack of a primary care provider, and chronic symptom duration predicted emergent presentation.
Conclusions:
- Findings suggest targets for increasing access to elective surgical care.
- Most emergent cases had chronic symptoms, indicating potential for prevention.
- Local population data can guide improvements in healthcare access and reduce emergency gallbladder surgeries.
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