Many Patients Face Emergency Gallbladder Surgery Delays: Study

Gallbladder disease is frequent issue in the U.S., yet many people who go to the emergency room with gallbladder pain are discharged, only to return within a month needing emergency surgery, according to the findings of new research. 

In a study published in the Journal of Surgical Research, researchers from the Mayo Clinic found that nearly one in five patients who are sent home from an emergency room to schedule gallbladder removal surgery later return to the ER needing emergency surgery.

Researchers studied the billing records of more than 3,000 patients at the Mayo Clinic in Rochester, Minn., between 2000 and 2013. Patients were treated in the ER for abdominal pain 30 days before undergoing gallbladder surgery.

More than 1,600 patients were admitted for emergency gallbladder removal surgery, known as a cholecystectomy. About 1,500 patients were sent home and instructed to schedule gallbladder removal. Of those sent home, 20% of patients returned to the ER within a month needing surgery urgently. Of those patients who returned, more than half of them returned to the ER within only one week of the first visit and required emergency surgery.

“It makes a big difference if you get the right treatment at the right time,” said co-author Juliane Bingener-Casey, M.D., gastroenterologic surgeon at Mayo Clinic, in a Mayo Clinic press release concerning the new study.

Of the patients discharged, younger patients who were otherwise healthy and older patients who had other health problems were more likely to return to the ER than patients who were in their 40s and 50s.

This information may suggest that patients who fit this demographic may benefit from a doctor taking a second look at the patient and their symptoms before being discharged, the study suggests.

Researchers analyzed the common indicators of gallbladder disease in the patients who returned to the ER. Some of those indicators include the white blood cell count, temperature and heart rate.

In the return patients, these indicators were no different than those of patients who left the ER and did not return for a repeat visit.

Gallstone Pain Common

Gallstone pain is one of most common reasons patients visit the ER in the United States. About one in 10 women and one in 15 men have gallstones, with more than 1 million people hospitalized for gallstone disease every year. Researchers indicate that the fatty food common in U.S. diets may be a contributing factor.

It is often difficult for doctors to figure out accurately who needs emergency gallbladder removal surgery and which patients can be sent home to schedule the surgery for a later date.

At times it can be obvious who needs emergency surgery and other times it cannot. However surgical complication rate rise significantly with time lag before surgery, especially a delay time of more than six days.

Surgical complications or requiring an emergency surgery may make patients more likely to need open-abdomen gallbladder surgery instead of minimally invasive laparoscopic procedure.

Researchers in this study are working to develop a reliable tool to help determine which cases need emergency surgery. They are calling this study the first step.