Not all cholecystitis is created equal: Disparities contributing to ED presentation and failure of the outpatient algorithm - 22/11/23
, Jonathan Ball , A Kathryn Patterson , Katherine B. Snyder , Morgan Bonds , Kenneth Stewart , Zoona Sarwar , Alexander R. Raines , Alisa Cross Abstract |
Background |
The majority of final surgical pathology (FSP) from both emergency department (ED) and outpatient clinic (OC) patients is chronic cholecystitis. We aimed to differentiate these presentations and identify disparities associated with ED utilization and OC failure.
Methods |
Retrospective chart review of single institution ED and OC cholecystectomies for cholelithiasis. Clinical presentation, FSP, demographics, and zip code poverty (ZCP) levels were evaluated. Data analysis by summary statistics, bivariate comparisons, and logistic regression.
Results |
Of 299 OC and 308 ED patients, OC was more likely to be Caucasian (78% vs 46%, p < 0.0001) and insured (89% vs. 32%, p < 0.0001). 71.8% of OC with ZCP <10% had insurance versus only 32.5% in ZCP >20%. Uninsured ED OR was 13.1 (95% CI 8.7–22.9).
Conclusion |
Uninsured ED patients are vulnerable to fail the outpatient algorithm, especially when misdiagnosed by US. Clinical diagnosis of cholecystitis in this population should warrant offering of urgent cholecystectomy.
Il testo completo di questo articolo è disponibile in PDF.Highlights |
• | Symptomatology and social factors determine location of patient presentation. |
• | Social determinants of health should be incorporated into surgical algorithm for cholecystectomy. |
• | Cholecystectomy should be offered at patient index encounter. |
Keywords : Emergency department, Cholecystectomy, Disparities, Insurance, Race, Cholecystitis, Cholelithiasis
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Vol 226 - N° 6
P. 835-839 - dicembre 2023 Ritorno al numero
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