Chest Pain, Family History, and Surgery: A Qualitative Interview Study of Cholecystectomy Patients

Symptomatic gallstone disease (sGD) is among the most common gastrointestinal illnesses requiring hospitalization, and cholecystectomy (CCY) is the most common abdominal general surgery in the US. Emergency CCY has a case fatality rate estimated to be 60-times higher than nonemergency CCY, yet both occur with equal frequency. The aim of this study is to generate hypotheses of patient-level factors influencing whether patients with sGD receive emergency or nonemergency CCY.

Semi-structured interviews were conducted with patients aged more than 18 who underwent either emergency or nonemergency CCY for sGD. Interview transcripts were coded and analyzed using ATLAS.ti.

Twenty-four patient interviews were conducted: 10 (42%) were emergency CCY patients and 14 (58%) were nonemergency CCY patients. There were no differences in age, sex, race, ethnicity, interview language, or insurance status between emergency and nonemergency CCY patient samples. Three key themes emerged: 1) physical symptoms of gallstone disease, 2) patient interpretation of gallstone disease symptoms, and 3) utilization of interpersonal social networks for discussion of gallstone disease. Specifically, patients reported that gallstone-related chest pain, a symptom which was interpreted by some patients as cardiac illness, influenced prompt care-seeking. Patients who had knowledge of their family history of gallstone disease prior to diagnosis reported being able to draw connections between their own symptoms and their family history, thus recognizing their need to seek care.

Chest pain and knowledge of family history may influence care-seeking behavior and surgical timing in sGD. These factors merit further investigation as potential modifiers of undergoing emergency and nonemergency CCY for prevention of emergency surgery and subsequent patient outcomes.