Cholecystectomy: Exploring the Interplay Between Access to Care and Emergent Presentation.

BACKGROUND: The burden of emergency general surgery leads to higher cost and less compensation to institutions; cholecystectomy accounts for >150,000 cases/y, the highest number of emergency general surgery cases that have a potentially elective course. We hypothesize that our cholecystectomy patient pool has unique characteristics informing health care access in our area. METHODS: We retrospectively identified cholecystectomy patients at our academic hospital over a 6-mo period from January to June of 2018 and classified them as emergent or elective. We excluded pregnant patients, patients aged <18 y, and patients who had undergone another major procedure concurrently. Patient demographics and clinical course were abstracted from the medical record. RESULTS: Two hundred and sixty-seven patients were included in the study, with most patients (n = 196, 73.4%) presenting emergently. We found no differences in age, sex, or BMI between the two groups. Emergent patients were more likely to be minorities, less likely to have insurance or a primary care physician, and 25% required an interpreter. Although a greater percentage of patients in the elective setting had chronic symptoms, most emergent patients also had duration of symptoms of months to years. After multivariable analysis, insurance status, lack of a primary care provider, and chronic duration of symptoms remained significant predictors of emergent presentation. CONCLUSIONS: Our findings indicate several targets for increasing access to elective surgical care. Most patients in the emergent group experienced chronic symptoms, indicating an opportunity to prevent emergency surgical treatment. This study provides local population characterization for improvements in access to care, which could lead to decreases in emergency gallbladder surgery.