Patients with complicated gallstone disease in the emergency department: clinical impact and cost-effectiveness of emergency department disposition decision

Authors

Michael Makutonin, Department of Emergency Medicine School of Medicine and Health Science George Washington University Washington District of Columbia USA.
Sophia Newton, Department of Emergency Medicine School of Medicine and Health Science George Washington University Washington District of Columbia USA.
Justin Tse, School of Medicine Virginia Commonwealth University Richmond Virginia USA.
Ali Moghtaderi, Department of Health Policy and Management The George Washington University (GWU) Milken Institute School of Public Health Washington District of Columbia USA.
Yan Ma, Department of Health Policy and Management The George Washington University (GWU) Milken Institute School of Public Health Washington District of Columbia USA.
Andrew C. Meltzer, Department of Emergency Medicine School of Medicine and Health Science George Washington University Washington District of Columbia USA.

Document Type

Journal Article

Publication Date

10-1-2022

Journal

Journal of the American College of Emergency Physicians open

Volume

3

Issue

5

DOI

10.1002/emp2.12795

Keywords

Acute cholecystitis; Biliary Colic; Biliary disease; Choecystectomy; Emergency Department; Gallstones; HCUP

Abstract

Objective: The objective of this study was to assess the 1-year outcomes of emergency department (ED) patients with complicated gallstone disease, including surgery rates, initial admission rates, ED revisits, repeat hospitalizations, and cost. Methods: Using 3 linked statewide databases from the Maryland Healthcare Cost and Utilization Project, we identified patients with a primary diagnosis of complicated gallstone disease treated in an ED between 2016 and 2018. We measured the healthcare use and direct costs in the ambulatory surgery, inpatient, and ED settings for 1 year after the initial ED visit. Finally, we performed a multivariate logistic regression analysis comparing initially admitted versus discharged patients. Results: Of the 8751 patients analyzed, 86.8% were admitted to the hospital and 13.2% were discharged on their initial ED visit. Of the admitted patients, 78.7% received a cholecystectomy during the initial hospitalization plus 6.1% at a later date; of the discharged patients, 41.5% received a cholecystectomy. Admitted patients demonstrated lower recurrent gallbladder complications compared with those discharged (7.5% vs 44.5%), fewer ED revisits (4% vs 20.3%), and fewer repeat hospitalizations (4.5% vs 16.7%). Despite this, the 1-year cost in the admitted patients was higher ($9448 vs $2933). Obesity, age, and mood disorders but not race, ethnicity, or zip code were associated with admission at initial ED visit. Conclusions: In our single-state analysis of ED patients with complications of gallstone disease, most patients are admitted on the initial visit and receive a cholecystectomy during that hospitalization. The discharged group had higher rates of 1-year complications, ED revisits, and repeat hospitalizations but lower cost.

APA Citation

Makutonin, Michael; Newton, Sophia; Tse, Justin; Moghtaderi, Ali; Ma, Yan; and Meltzer, Andrew C., "Patients with complicated gallstone disease in the emergency department: clinical impact and cost-effectiveness of emergency department disposition decision" (2022). GW Authored Works. Paper 1771.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1771

Department

Emergency Medicine