Referral practices are associated with a delay in treatment of symptomatic cholelithiasis and cholecystitis - 12/12/23

Doi : 10.1016/j.amjsurg.2023.09.041

LT Brittany Cook ^a,^b,^⁎,^{^{1
AWS Members.}} , MAJ.Rathnayaka M.K.D. Gunasingha ^a,^b,^{^{1
AWS Members.}}, LT Sydney Dishman ^b,^c,^d,^{^{1
AWS Members.}}, LT Megan Bartel ^a,^b,^{^{1
AWS Members.}}, CDR Matthew Bradley ^a,^b, LCDR Carolyn Gosztyla ^a,^b,^d,^{^{1
AWS Members.}}
^a Uniformed Services University of the Health Sciences, 4301 Jones Bridge Ave, Bethesda, MD, 20814, USA
^b Department of Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA
^c Naval Medical Center Portsmouth Department of Aviation Medicine, Carrier Air Wing Three, USA
^d En Route and Critical Care Research Department, Naval Medical Research Center, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA

^∗Corresponding author. 8901 Wisconsin Ave, Bethesda, MD, 20852, USA.8901 Wisconsin AveBethesdaMD20852USA

Abstract

Background

The project was performed to determine if referrals to non-surgical providers after an initial presentation of symptomatic cholelithiasis are associated with a delay in surgical management.

Methods

A single institution chart review of all adult patients who underwent a cholecystectomy from 2015 to 2019 was completed. Quantitative data was analyzed using independent t-tests.

Results

Of 574 reviewed, 482 patients met criteria. Following initial presentation, 295 (61.2%) received a referral to surgery and 187 (38.8%) received follow up with a non-surgical provider. Those in the latter group had a significantly longer time from initial symptom presentation to surgical evaluation (65.7 days vs. 10.3 days, p < 0.001) and cholecystectomy (102.0 days vs 39.1 days, p < 0.001) when compared to the surgery referral group.

Conclusions

This study demonstrated that cholecystectomy was significantly delayed for patients who had been referred to non-surgical providers after initial presentation, prolonging symptoms and increasing use of healthcare resources.

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Highlights

•	Non-surgical referrals for biliary colic are associated with delays to surgery.
•	Non-surgical referrals for biliary colic corelate with increased resource utilization.
•	Referral processes should be optimized for surgical management of biliary colic.

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Keywords : Cholecystitis, Cholelithiasis, Biliary colic, Referral

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Vol 227

P. 96-99 - janvier 2024 Retour au numéro

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Referral practices are associated with a delay in treatment of symptomatic cholelithiasis and cholecystitis - 12/12/23

Abstract

Background

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Conclusions

Highlights

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