title: Hospital readmission after emergency room visit for cholelithiasis.
abstract: BACKGROUND
  For patients presenting with symptomatic cholelithiasis, cholecystectomy is the definitive treatment modality. Our goal was to evaluate the surgical follow-up and outcomes in patients seen in the emergency department (ED) for an episode of symptomatic cholelithiasis and discharged home for elective follow-up.
  
  
  METHODS
  We performed a retrospective review of consecutive patients seen in the ED for cholelithiasis and discharged without hospital admission between August 2009 and May 2014. All patients were followed for 2 y from the date of the initial ED visit. We evaluated outpatient surgeon visits, elective and emergent cholecystectomy rates, and additional ED visits. Cumulative incidence and Kaplan-Meier curves were used to examine the time from the initial ED visit to outpatient surgeon evaluation and the time from the initial ED visit to ED readmission.
  
  
  RESULTS
  Seventy-one patients were discharged from the ED with a diagnosis of symptomatic gallstones. Patients who had an elective cholecystectomy in the 2 y after the initial visit were 12.6%. In this group, the mean time from the initial ED visit to outpatient surgeon follow-up was 7.7 d, and all elective cholecystectomies occurred within 1 mo of the initial visit. Of the 62 patients who did not have an elective cholecystectomy, only 14.5% of patients in this group had outpatient surgeon follow-up at mean time of 137 d from the initial ED visit for symptomatic gallstones. In addition, 37.1% of patients in this group had additional ED visits for gallstone-related symptoms, with 17.7% of patients having two or more additional ED visits, and 12.9% required emergent and/or urgent cholecystectomy. Additional ED visits (43.5%) occurred within 1 mo and 60.9% within 3 mo of their initial ED visit. In patients with additional ED visits for symptomatic cholelithiasis, 60.9% had more than one abdominal ultrasound or computed tomography scan during the course of multiple visits.
  
  
  CONCLUSIONS
  Failure to achieve a timely surgical follow-up leads to multiple ED readmissions and emergent gallstone-related hospitalizations, including emergency cholecystectomy. System-level interventions to ensure outpatient surgical follow-up within 1-2 wk of the initial ED visit has the potential to improve outcomes for patients with symptomatic biliary colic.
authors.affiliation: Department of Surgery, The University of Texas Medical Branch, Galveston, Texas.
authors.forename: Taylor P
authors.initials: TP
authors.lastname: Williams
authors.affiliation: Department of Surgery, The University of Texas Medical Branch, Galveston, Texas; Department of Surgery, University of South Florida, Tampa, Florida.
authors.forename: Francesca M
authors.initials: FM
authors.lastname: Dimou
authors.affiliation: Department of Surgery, The University of Texas Medical Branch, Galveston, Texas.
authors.forename: Deepak
authors.initials: D
authors.lastname: Adhikari
authors.affiliation: Department of Surgery, The University of Texas Medical Branch, Galveston, Texas.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Kimbrough
authors.affiliation: Department of Surgery, The University of Texas Medical Branch, Galveston, Texas. Electronic address: tsriall@utmb.edu.
authors.forename: Taylor S
authors.initials: TS
authors.lastname: Riall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D002769:Cholelithiasis / Q000601:surgery*; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: Cholecystectomy; Cholelithiasis; Emergency department; Emergency room; Gallstone disease; Gallstones; Symptomatic cholelithiasis