A critical view: Examining disparities regarding timely cholecystectomy

Area of Science:

• Health Services Research
• Surgical Outcomes
• Health Equity

Background:

• Implicit bias can impede optimal patient workup and treatment.
• Patients from socially disadvantaged backgrounds may face delays in operative care for cholecystitis.

Purpose of the Study:

• To investigate factors associated with prior emergency department visits within 3 months of urgent cholecystectomy.
• To examine the relationship between patient demographics and delayed surgical treatment for cholecystitis.

Main Methods:

• Retrospective analysis of 508 patients undergoing urgent cholecystectomy (July 2019 - December 2022).
• Examined patient factors including age, race, ethnicity, language, insurance, and employment.
• Used bivariate comparisons and logistic regression to identify associations with prior emergency department visits.

Main Results:

• 27.2% of patients had a prior emergency department visit within 3 months of surgery.
• Younger age, Black race, Hispanic ethnicity, non-English language preference, and specific insurance types were associated with prior visits.
• Logistic regression confirmed associations between younger age, Black race, Hispanic ethnicity, Medicare, or uninsured status and higher odds of prior emergency department visits.

Conclusions:

• Over a quarter of patients had recent abdominal pain evaluations before urgent cholecystectomy.
• Patients from socially disadvantaged backgrounds were more likely to have these prior evaluations.
• Standardized abdominal pain evaluation pathways are crucial to mitigate disparities stemming from implicit bias.