Biliary colic in the emergency department: A state-wide analysis of one-year costs and clinical outcomes
Importance: Approximately 335,000 cases of biliary colic present to US emergency departments (EDs) annually, and most patients without complications are discharged from the ED. It is unknown what are the subsequent surgery rates, subsequent complications of biliary disease, ED revisits, repeat hospi...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | Surgery Open Science |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589845023000039 |
| _version_ | 1797867426512109568 |
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| author | Michael Makutonin Ali Moghatederi Sophia Newton Yan Ma Andrew C. Meltzer |
| author_facet | Michael Makutonin Ali Moghatederi Sophia Newton Yan Ma Andrew C. Meltzer |
| author_sort | Michael Makutonin |
| collection | DOAJ |
| description | Importance: Approximately 335,000 cases of biliary colic present to US emergency departments (EDs) annually, and most patients without complications are discharged from the ED. It is unknown what are the subsequent surgery rates, subsequent complications of biliary disease, ED revisits, repeat hospitalizations and cost; and, how does the ED disposition decision (admission versus discharge) affect long-term outcomes. Objective: To determine whether there is a difference in one-year surgery rates, complications of biliary disease, ED revisits, repeat hospitalizations, and cost in ED patients with uncomplicated biliary colic who are admitted to the hospital versus those that are discharged from the ED. Design, setting, and participants: A retrospective observational study was conducted using records collected from the Maryland Healthcare Cost and Utilization Project (HCUP) in the Ambulatory Surgery, the Inpatient, and the ED setting between 2016 and 2018. After applying inclusion criteria, 7036 ED patients with uncomplicated biliary colic were followed for one year after their index ED visit for repeat healthcare utilization across multiple settings. A multivariable logistic regression study was performed to asses for risk factors for surgery allocation and hospital admission. Medicare Relative Value Units (RVUs) and HCUP Cost-Charge Ratio files were used to estimate direct costs. Exposures: Episodes of biliary colic were ascertained using ICD-10 codes at the index ED visit. Main outcomes and measures: The primary outcome was the one-year surgery rate, defined as a cholecystectomy. Secondary outcomes included the rate of new acute cholecystitis or other related complications, ED revisits, hospital admission and costs. Associations with hospital admission and surgeries were measured using adjusted odds ratios (ORs) with 95 % CIs. Results: Of the 7036 patients analyzed, 793 (11.3 %) were admitted and 6243 (88.7 %) were discharged on their initial ED visit. When comparing the groups who were initially admitted versus discharged, we observed similar one-year cholecystectomy rates (42 % versus 43 %, mean difference 0.5 %, 95 % CI −3.1 %–4.2 %; P < 0.001), lower rates of new cholecystitis occurrences (18 % versus 41 %, mean difference 23 %, 95 % CI, 20 %–26 %; P < 0.001), lower rates of ED revisits (96 vs 198 per 1000 patients, mean difference 102, 95 % CI, 74–130; P < 0.001) and higher costs ($9880 versus $1832, mean difference 8048, 95 % CI, 7478–8618; P < 0.001). Initial ED hospital admission was associated with increased age (adjusted odds ratio [aOR], 1.44; 95 % CI, 1.35–1.53; P < 0.001), obesity (aOR, 1.38; 95 % CI, 1.32–1.44; P < 0.001), ischemic heart disease (aOR, 1.39; 95 % CI, 1.30–1.48; P < 0.001), mood disorders (aOR, 1.18; 95 % CI, 1.13–1.24; P < 0.001), alcohol-related disorders (aOR, 1.20; 95 % CI, 1.12–1.27; P < 0.001), hyperlipidemia (aOR, 1.16; 95 % CI, 1.09–1.23; P < 0.001), hypertension (aOR, 1.15; 95 % CI, 1.08–1.21; P < 0.001), and nicotine dependence (aOR, 1.09; 95 % CI, 1.03–1.15; P = 0.003) but not associated with race (P > 0.9), ethnicity (P > 0.9), or income-stratified zip code (aOR, 1.04; 95 % CI, 0.98–1.09; P = 0.17). Conclusions and relevance: In our analysis of ED patients with uncomplicated biliary colic from a single state, the majority of patients do not receive a cholecystectomy within one year and hospital admission at the initial visit was not associated with an overall change in rates of cholecystectomy but was associated with increased costs. These findings inform our understanding of the long-term outcomes and are important considerations when communicating care options with ED patients with biliary colic. |
| first_indexed | 2024-04-09T23:40:01Z |
| format | Article |
| id | doaj.art-f057b7ad9f79423ebbcf0b5509a4f864 |
| institution | Directory Open Access Journal |
| issn | 2589-8450 |
| language | English |
| last_indexed | 2024-04-09T23:40:01Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Surgery Open Science |
| spelling | doaj.art-f057b7ad9f79423ebbcf0b5509a4f8642023-03-19T04:38:23ZengElsevierSurgery Open Science2589-84502023-03-0112913Biliary colic in the emergency department: A state-wide analysis of one-year costs and clinical outcomesMichael Makutonin0Ali Moghatederi1Sophia Newton2Yan Ma3Andrew C. Meltzer4Department of Emergency Medicine, School of Medicine and Health Science, George Washington University, Washington DC 20037, United States of AmericaDepartment of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, United States of AmericaDepartment of Emergency Medicine, School of Medicine and Health Science, George Washington University, Washington DC 20037, United States of AmericaDepartment of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, United States of AmericaDepartment of Emergency Medicine, School of Medicine and Health Science, George Washington University, Washington DC 20037, United States of America; Corresponding author at: Department of Emergency Medicine, GWU School of Medicine & Health Sciences, 2120 L Street NW Suite 450, Washington DC 20037, United States of America.Importance: Approximately 335,000 cases of biliary colic present to US emergency departments (EDs) annually, and most patients without complications are discharged from the ED. It is unknown what are the subsequent surgery rates, subsequent complications of biliary disease, ED revisits, repeat hospitalizations and cost; and, how does the ED disposition decision (admission versus discharge) affect long-term outcomes. Objective: To determine whether there is a difference in one-year surgery rates, complications of biliary disease, ED revisits, repeat hospitalizations, and cost in ED patients with uncomplicated biliary colic who are admitted to the hospital versus those that are discharged from the ED. Design, setting, and participants: A retrospective observational study was conducted using records collected from the Maryland Healthcare Cost and Utilization Project (HCUP) in the Ambulatory Surgery, the Inpatient, and the ED setting between 2016 and 2018. After applying inclusion criteria, 7036 ED patients with uncomplicated biliary colic were followed for one year after their index ED visit for repeat healthcare utilization across multiple settings. A multivariable logistic regression study was performed to asses for risk factors for surgery allocation and hospital admission. Medicare Relative Value Units (RVUs) and HCUP Cost-Charge Ratio files were used to estimate direct costs. Exposures: Episodes of biliary colic were ascertained using ICD-10 codes at the index ED visit. Main outcomes and measures: The primary outcome was the one-year surgery rate, defined as a cholecystectomy. Secondary outcomes included the rate of new acute cholecystitis or other related complications, ED revisits, hospital admission and costs. Associations with hospital admission and surgeries were measured using adjusted odds ratios (ORs) with 95 % CIs. Results: Of the 7036 patients analyzed, 793 (11.3 %) were admitted and 6243 (88.7 %) were discharged on their initial ED visit. When comparing the groups who were initially admitted versus discharged, we observed similar one-year cholecystectomy rates (42 % versus 43 %, mean difference 0.5 %, 95 % CI −3.1 %–4.2 %; P < 0.001), lower rates of new cholecystitis occurrences (18 % versus 41 %, mean difference 23 %, 95 % CI, 20 %–26 %; P < 0.001), lower rates of ED revisits (96 vs 198 per 1000 patients, mean difference 102, 95 % CI, 74–130; P < 0.001) and higher costs ($9880 versus $1832, mean difference 8048, 95 % CI, 7478–8618; P < 0.001). Initial ED hospital admission was associated with increased age (adjusted odds ratio [aOR], 1.44; 95 % CI, 1.35–1.53; P < 0.001), obesity (aOR, 1.38; 95 % CI, 1.32–1.44; P < 0.001), ischemic heart disease (aOR, 1.39; 95 % CI, 1.30–1.48; P < 0.001), mood disorders (aOR, 1.18; 95 % CI, 1.13–1.24; P < 0.001), alcohol-related disorders (aOR, 1.20; 95 % CI, 1.12–1.27; P < 0.001), hyperlipidemia (aOR, 1.16; 95 % CI, 1.09–1.23; P < 0.001), hypertension (aOR, 1.15; 95 % CI, 1.08–1.21; P < 0.001), and nicotine dependence (aOR, 1.09; 95 % CI, 1.03–1.15; P = 0.003) but not associated with race (P > 0.9), ethnicity (P > 0.9), or income-stratified zip code (aOR, 1.04; 95 % CI, 0.98–1.09; P = 0.17). Conclusions and relevance: In our analysis of ED patients with uncomplicated biliary colic from a single state, the majority of patients do not receive a cholecystectomy within one year and hospital admission at the initial visit was not associated with an overall change in rates of cholecystectomy but was associated with increased costs. These findings inform our understanding of the long-term outcomes and are important considerations when communicating care options with ED patients with biliary colic.http://www.sciencedirect.com/science/article/pii/S2589845023000039Biliary diseaseBiliary colicGallstonesAcute cholecystitisHCUPCholecystectomy |
| spellingShingle | Michael Makutonin Ali Moghatederi Sophia Newton Yan Ma Andrew C. Meltzer Biliary colic in the emergency department: A state-wide analysis of one-year costs and clinical outcomes Surgery Open Science Biliary disease Biliary colic Gallstones Acute cholecystitis HCUP Cholecystectomy |
| title | Biliary colic in the emergency department: A state-wide analysis of one-year costs and clinical outcomes |
| title_full | Biliary colic in the emergency department: A state-wide analysis of one-year costs and clinical outcomes |
| title_fullStr | Biliary colic in the emergency department: A state-wide analysis of one-year costs and clinical outcomes |
| title_full_unstemmed | Biliary colic in the emergency department: A state-wide analysis of one-year costs and clinical outcomes |
| title_short | Biliary colic in the emergency department: A state-wide analysis of one-year costs and clinical outcomes |
| title_sort | biliary colic in the emergency department a state wide analysis of one year costs and clinical outcomes |
| topic | Biliary disease Biliary colic Gallstones Acute cholecystitis HCUP Cholecystectomy |
| url | http://www.sciencedirect.com/science/article/pii/S2589845023000039 |
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