Sharon Theimer, Mayo Clinic
Study: younger, older people likelier to visit ER repeatedly with gallstone pain before surgery
Gallstone pain is one of the most common reasons patients visit emergency rooms. Figuring out who needs emergency
gallbladder
removal and who can go home and schedule surgery at their convenience
is sometimes a tricky question, and it isn’t always answered correctly. A
new Mayo Clinic study found that 1 in 5 patients who went to the
emergency room with gallbladder pain and were sent home to schedule
surgery returned to the ER within 30 days needing emergency gallbladder
removal. The surgical complication rate rises with the time lag before
surgery, the researchers say.
“It makes a big difference if you get the right treatment at the
right time,” says co-lead author Juliane Bingener-Casey, M.D., a
gastroenterologic surgeon at Mayo Clinic in Rochester. The study is
published in the
Journal of Surgical Research.
Often it’s obvious who needs emergency gallbladder removal, a procedure known as
cholecystectomy,
who can delay it and who doesn’t need surgery at all. But sometimes
patients fall into a gray area. Mayo researchers are working to develop a
reliable tool to help determine the best course of action in those
cases, and the newly published study is a first step, Dr. Bingener-Casey
says.
How to handle gallstone patients is a cost and quality issue in
health care. In the United States, 1 in 10 women and 1 in 15 men have
gallstones, and more than 1 million people a year are hospitalized for
gallstone disease. The fatty food common in U.S. diets is a contributing
factor, Dr. Bingener-Casey says.
ER visits and emergency surgery are typically more expensive than
scheduled surgeries. In addition to cost issues, patients often prefer
the convenience of scheduling surgery, so they can arrange child care
and leave from work, for example. But delaying a needed gallbladder
removal more than six days increases the surgical complication rate and
may make patients likelier to need open-abdomen surgery rather than a
minimally invasive laparoscopic procedure, the researchers noted.
“Gallbladder disease is very frequent and it’s one of the most
expensive diseases for the nation as a whole. If we can get that right
the first time, I think we can make things better for a lot of people,”
Dr. Bingener-Casey says.
Researchers studied the billing records of 3,138 patients at Mayo in
Rochester between 2000 and 2013 who went to the emergency department for
abdominal pain within 30 days before gallbladder surgery. Of those,
1,625 were admitted for emergency gallbladder surgery, and 1,513 were
allowed to go home and schedule surgery at a later date. Of the patients
who went home, 20 percent came back to the emergency room within a
month needing a cholecystectomy urgently, and of those, 55 percent were
back in the ER within a week for emergency surgery.
[ Watch: Emergency Gallstone Surgery: Do You Need It, Or Can You Afford To Wait? ]
Among those discharged from the ER, younger patients who were
otherwise healthy and older patients who did have other health problems
were likelier than people in their 40s and 50s to return to the
emergency room within a month and need gallbladder removal urgently, the
study found. That suggests that younger patients, older patients and
those with other serious medical conditions may benefit from a second
look before they are discharged from the emergency room, the researchers
say.
Researchers analyzed test results typically considered indicators of
gallbladder disease including white blood cell count, temperature and
heart rate and saw no difference between those who left the ER and
didn’t make a repeat visit and those who left the emergency room only to
come back within a month. Such metrics may be incorporated into a
decision tool if they hold up during future research.
http://www.redorbit.com/news/health/1113211859/emergency-gallbladder-surgery-tool-mayo-clinic-081314/
