Early Return as a Predictor of Recidivism in Patients with Cholelithiasis

• Published in: Academic emergency medicine Vol. 10; no. 5; pp. 532 - 533
• Main Author: Mills, L. D
• Format: Journal Article
• Language: English
• Published: Des Plaines Wiley Subscription Services, Inc 01.05.2003
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1197/aemj.10.5.532-b

OBJECTIVE: To determine patterns of recidivism in Emergency Department (ED) patients with suspected cholelithiasis (CL). METHODS: This IRB approved, prospective study was conducted at a county hospital from 6/01 to 6/02. Patients, age 18 to 65 years, evaluated for cholecystitis were consecutively enrolled. These patients were followed by a computerized triage system to identify repeat visits. Prior visits to other EDs were included in data analysis. Number of visits, time between visits, diagnosis and disposition were recorded. Data was analyzed using a two-sided Fisher's Exact test with SPSS software. RESULTS: One hundred fifty-seven patients were enrolled. Thirty percent (46/157) had multiple ED visits for abdominal pain. Patients with multiple visits were significantly less likely to have an acute process (cholecystitis, biliary pancreatitis or choledocholithiasis) on the first visit than patients with only one visit (p < 0.000). Eighty percent (37/46) of the patients with multiple visits to the ED were determined to have CL. In the group with CL, patients with 2 visits in a 31day period had a significantly increased chance of having 3 or more total visits compared to patients whose visits were farther apart (p = 0.001). Patients with CL were significantly more likely to be admitted on subsequent visits than patients with other causes of abdominal pain (p < 0.000). Number and size of gallstones did not correlate with number of visits (p = 0.06). CONCLUSION: This study identifies patterns of presentation among patients with multiple visits to the ED for CL. These patients were less likely to have an acute process on the first visit. Patients with 2 visits in 31 days were likely to have 3 or more visits to the ED. This study indicates that same-visit cholecystectomy in patients with one early return visit may affect health care savings.