Socially vulnerable patients are more likely to fail outpatient management of symptomatic cholelithiasis

Udai S Sibia; John R Klune; Cristina B Feather; Deanna Rider; Douglas A Hanes; Richard Essner

doi:10.1016/j.gassur.2024.04.017

Socially vulnerable patients are more likely to fail outpatient management of symptomatic cholelithiasis

J Gastrointest Surg. 2024 Apr 22:S1091-255X(24)00418-9. doi: 10.1016/j.gassur.2024.04.017. Online ahead of print.

Authors

Udai S Sibia¹, John R Klune², Cristina B Feather², Deanna Rider³, Douglas A Hanes³, Richard Essner³

Affiliations

¹ Saint John's Cancer Institute, Providence Health & Services, Santa Monica, CA, United States. Electronic address: udai.sibia@providence.org.
² Department of Surgery, Anne Arundel Medical Center, Luminis Health, Annapolis, MD, United States.
³ Saint John's Cancer Institute, Providence Health & Services, Santa Monica, CA, United States.

PMID: 38657729
DOI: 10.1016/j.gassur.2024.04.017

Abstract

Background: Symptomatic cholelithiasis is a common surgical problem, with many patients requiring multiple gallstone-related emergency department (ED) visits before cholecystectomy. The Social Vulnerability Index (SVI) identifies vulnerable patient populations. This study aimed to assess the association between social vulnerability and outpatient management of symptomatic cholelithiasis.

Methods: Patients with symptomatic cholelithiasis-related ED visits were identified within our health system from 2016 to 2022. Clinical outcomes data were merged with SVI census track data, which consist of 4 SVI subthemes (socioeconomic status, household characteristics, racial and ethnic minority status, and housing type and transportation). Multivariate analysis was used for statistical analysis.

Results: A total of 47,292 patients presented to the ED with symptomatic cholelithiasis, of which 6103 patients (13.3 %) resided in vulnerable census tract regions. Of these patients, 13,795 (29.2 %) underwent immediate cholecystectomy with a mean time to surgery of 35.1 h, 8250 (17.4 %) underwent elective cholecystectomy at a mean of 40.6 days from the initial ED visit, and 2924 (6.2 %) failed outpatient management and returned 1.26 times (range, 1-11) to the ED with recurrent biliary-related pain. Multivariate analysis found social vulnerability subthemes of socioeconomic status (odds ratio [OR], 1.29; 95 % CI, 1.09-1.52) and racial and ethnic minority status (OR, 2.41; 95 % CI, 2.05-2.83) to be associated with failure of outpatient management of symptomatic cholelithiasis.

Conclusion: Socially vulnerable patients are more likely to return to the ED with symptomatic cholelithiasis. Policies to support this vulnerable population in the outpatient setting with timely follow-up and elective cholecystectomy can help reduce delays in care and overutilization of ED resources.

Keywords: Cholecystectomy; Management; Social Vulnerability Index; Symptomatic cholelithiasis.