How Many Patients Sent Home From ER With Gallbladder Pain Eventually Need Surgery?

Dr. Juliane Bingener-Casey, M.D. Mayo Clinic in Rochester, Minn.MedicalResearch.com Interview with:
Dr. Juliane Bingener-Casey, M.D.
Mayo Clinic in Rochester, Minn.

 


Medical Research: What are the main findings of the study?  

Dr. Bingener-Casey: “About half of patients seeking emergency care for gallbladder problems were immediately admitted and underwent urgent cholecystectomy, the other half went home. The half that went home was younger and had lower WBC counts, lower neutrophils and less people with elevated temperature than the patients immediately admitted. Of the half that went home, 31% returned at least once to the ED within 30 days and 20% were admitted to undergo urgent cholecystectomy after the return visit, 55% percent of those within 7 days of the initial ED visit. Patients who failed the elective treatment plan had similar WBC counts but were more likely to have an ASA >3, slightly higher creatinine and higher average maximum VAS pain score. Patients who were less than 40 years old or older than 60 years were more likely to fail the elective pathway.”

Medical Research: Were any of the findings unexpected?

Dr. Bingener-Casey: “The proportion of patients requiring return visits was higher than expected and that young people were more likely to fail the elective treatment plan.”

Medical Research: What should clinicians and patients take away from your report?

Dr. Bingener-Casey: “It will be helpful for patients and clinicians to understand the likelihood of readmission, that might change their initial management or preferences. It is also important to note that young patients may be at higher risk and patients who are older and have more comorbidities. Our study provides information for an informed discussion to develop treatment plans after emergency room visits for gallbladder disease, keeping in mind that delayed surgery for undiagnosed acute cholecystitis carries a higher risk of complications.”

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Bingener-Casey: “We would like to see a predictive model developed that could help clinicians and patients understand at the initial ED visit what their likelihood of failure with an elective treatment plan is. Patients and clinicians may then be able to select the most effective course and avoid unnecessary pain, risk of complications and cost for families and health care systems.”

Citation:

Success of elective cholecystectomy treatment plans after emergency department visit
Journal of Surgical Research ( 2 0 1 4 ) 1e7
Juliane Bingener, MD,a,* Kristine M. Thomsen, BA
Andrea McConico, BA, AS,a Erik P. Hess, MD
and Elizabeth B. Habermann, PhD