Not all cholecystitis is created equal: Disparities contributing to ED presentation and failure of the outpatient algorithm

W Taylor Martin; Jonathan Ball; A Kathryn Patterson; Katherine B Snyder; Morgan Bonds; Kenneth Stewart; Zoona Sarwar; Alexander R Raines; Alisa Cross

doi:10.1016/j.amjsurg.2023.06.038

Not all cholecystitis is created equal: Disparities contributing to ED presentation and failure of the outpatient algorithm

Am J Surg. 2023 Dec;226(6):835-839. doi: 10.1016/j.amjsurg.2023.06.038. Epub 2023 Jul 13.

Authors

W Taylor Martin¹, Jonathan Ball², A Kathryn Patterson³, Katherine B Snyder⁴, Morgan Bonds⁵, Kenneth Stewart⁶, Zoona Sarwar⁷, Alexander R Raines⁸, Alisa Cross⁹

Affiliations

¹ University of Oklahoma General Surgery Department, USA. Electronic address: [email protected].
² University of Oklahoma General Surgery Department, USA. Electronic address: [email protected].
³ University of Oklahoma General Surgery Department, USA. Electronic address: [email protected].
⁴ University of Oklahoma General Surgery Department, USA. Electronic address: [email protected].
⁵ University of Oklahoma General Surgery Department, USA. Electronic address: [email protected].
⁶ University of Oklahoma General Surgery Department, USA. Electronic address: [email protected].
⁷ University of Oklahoma General Surgery Department, USA. Electronic address: [email protected].
⁸ University of Oklahoma General Surgery Department, USA. Electronic address: [email protected].
⁹ University of Oklahoma General Surgery Department, USA. Electronic address: [email protected].

PMID: 37481409
DOI: 10.1016/j.amjsurg.2023.06.038

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.

Keywords: Cholecystectomy; Cholecystitis; Cholelithiasis; Disparities; Emergency department; Insurance; Race.

MeSH terms

Cholecystectomy
Cholecystitis* / diagnosis
Cholecystitis* / surgery
Emergency Service, Hospital
Humans
Outpatients*
Retrospective Studies