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Not all cholecystitis is created equal: Disparities contributing to ED presentation and failure of the outpatient
W Taylor Martin1, Jonathan Ball1, A Kathryn Patterson1
1University of Oklahoma General Surgery Department, USA.
Insights
Uninsured patients undergoing cholecystectomy via the emergency department (ED) are at higher risk of treatment failure. This highlights disparities in care for gallstone disease, particularly for vulnerable populations.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Health Services Research
Background:
- Chronic cholecystitis is the predominant final surgical pathology for both emergency department (ED) and outpatient clinic (OC) patients.
- Disparities in ED utilization and OC failure require differentiation between these patient groups.
Purpose of the Study:
- To differentiate presentations of chronic cholecystitis between ED and OC patients.
- To identify disparities in care associated with ED utilization and OC failure.
Main Methods:
- Retrospective chart review of cholecystectomies for cholelithiasis at a single institution.
- Evaluation of clinical presentation, final surgical pathology, demographics, and zip code poverty (ZCP).
- Data analysis using summary statistics, bivariate comparisons, and logistic regression.
Main Results:
- Outpatient clinic (OC) patients were more likely to be Caucasian and insured compared to emergency department (ED) patients.
- Insurance rates decreased significantly with increasing zip code poverty (ZCP) levels.
- Uninsured ED patients had a significantly higher odds ratio (OR) for adverse outcomes.
Conclusions:
- Uninsured ED patients are vulnerable to failing the outpatient algorithm, especially with misdiagnosis by ultrasound.
- Clinical diagnosis of cholecystitis in this population warrants offering urgent cholecystectomy.
Background:
The majority of final surgical pathology (FSP) from both emergency department (ED) and outpatient clinic (OC) patients is chronic cholecystitis. We aimed to differentiate these presentations and identify disparities associated with ED utilization and OC failure.
Methods:
Retrospective chart review of single institution ED and OC cholecystectomies for cholelithiasis. Clinical presentation, FSP, demographics, and zip code poverty (ZCP) levels were evaluated. Data analysis by summary statistics, bivariate comparisons, and logistic regression.
Results:
Of 299 OC and 308 ED patients, OC was more likely to be Caucasian (78% vs 46%, p < 0.0001) and insured (89% vs. 32%, p < 0.0001). 71.8% of OC with ZCP <10% had insurance versus only 32.5% in ZCP >20%. Uninsured ED OR was 13.1 (95% CI 8.7-22.9).
Conclusion:
Uninsured ED patients are vulnerable to fail the outpatient algorithm, especially when misdiagnosed by US. Clinical diagnosis of cholecystitis in this population should warrant offering of urgent cholecystectomy.
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