Background: A previous investigation at a midwestern ED found that 20% of patients discharged with biliary colic returned within 30-days for urgent cholecystectomy. We evaluated the 30-day return visit patterns within our multi-hospital system for a cohort of biliary colic patients discharged from a single-site ED that serves a predominantly urban, poor, Hispanic population.
Methods: >This was a retrospective cohort study at a teaching facility ED. We reviewed billing data to identify patients seen during 9/1/2012-9/1/2018 with a final ED ICD-10 diagnosis of biliary colic at the study site. Subsequently, we conducted structured EMR review of visits to any of six intrasystem hospitals within a 12-county area, representing the majority of the region’s hospital-based ED visits. Categorical data analyzed by Fisher Exact or Chi-square tests; continuous data analyzed by t-tests. Odds ratios and 95% CIs calculated. The primary outcome parameter was the proportion of patients initially discharged from the ED who then returned to the ED within 30 days.
Results: 103 patients with biliary colic identified. 87 were initially discharged from the ED, including: 77% female, 89% < 65 years, 82% Hispanic, 45% with private insurance, 79% patients without prior biliary disease. On initial visit, 70% of discharged patients had an ultrasound (US), 13% CT and 2% HIDA. 4 patients were sent home after surgical consultation. For our primary outcome, 21(24%; 95% CI 16%-34%) of patients discharged from the initial visit were seen in the ED within 30 days; 5(6%) were seen more than once in that period; 2(10%) underwent cholecystectomy. There were no significant associations between the following variables and return visit within 30 days: gender (p = 0.49: OR 0.64; 95% CI 0.22-2.0), Hispanic race (p=0.34; OR 0.39; 95% CI 0.08-1.9), age (p= 0.86; OR 1.1; 95% CI 0.35-3.49), private insurance (p = 0.22; OR 0.53; 95% CI 0.19-1.5), history of biliary disease (p= 0.10; OR 2.5; 95% CI 0.82-7.6), US initial ED visit (p = 0.88; OR 1.1; 95% CI 0.37-3.2), CT on initial ED visit (p=0.28; OR 0.28: 95% CI 0.03-2.3). There were no associations observed between patient characteristics and cholecystectomy within 30 days.
Conclusions: Within our urban ED cohort, the proportion of biliary colic patients that revisited within 30 days was similar to prior reports but the frequency of cholecystectomy upon return was markedly lower.