Barriers to elective cholecystectomy following emergency department discharge for symptomatic cholelithiasis

Abstract

BackgroundPatients with symptomatic cholelithiasis are often discharged from the Emergency Department (ED) and asked to follow-up for elective cholecystectomy. We aimed to identify the social determinants of health (SDOH) that serve as barriers to elective cholecystectomy and to assess the associated impact on patient outcomes. MethodsWe conducted a multi-institutional, retrospective cohort study of patients discharged from the ED with symptomatic cholelithiasis. Univariable logistic regression was used to assess for variables associated with re-presenting to the ED rather than for elective cholecystectomy. P values ​< ​0.05 identified significance. ResultsUnivariate analysis identified lack of a primary care physician, Black race, self-pay, language other than English as the primary language, and unemployed status to be independently associated with re-presentation to the ED for biliary disease. ConclusionsSocially disadvantaged populations would benefit from surgery at the time of presentation to the ED versus being sent home for elective follow-up.