In the Journals

Half of patients with gallstone disease do not receive timely cholecystectomy

A recent study showed that half of all patients with gallstone disease are not receiving timely cholecystectomy, which can increase their risk for subsequent complications.

Patients from certain disadvantaged ethnic and socioeconomic groups were particularly less likely to have their gallbladders removed after a gallstone attack, researchers noted.

“We didn’t suspect it was such a large portion of the population that wasn’t getting this relatively straightforward surgery,” Robert Huang, MD, MS, of the division of gastroenterology and hepatology at Stanford University Medical Center, said in an article on Stanford University School of Medicine’s blog, Scope. “We were surprised that only 50% of Americans (with gallstone disease) were receiving this surgery.”

To assess the effects of delayed cholecystectomy, Huang and colleagues reviewed data from ambulatory surgery, inpatient and emergency department databases from California, New York and Florida, and identified 4,516 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) after being hospitalized with choledocholithiasis between 2009 and 2014. Then they compared outcomes between patients who had early cholecystectomy at their index admission (41.2%), delayed elective cholecystectomy within 2 months of discharge (10.9%), or no cholecystectomy (48%).

They found that while both early and delayed cholecystectomy were comparably effective for reducing the risk for recurrent biliary events, patients had a 10-fold higher risk for a recurrent biliary event while waiting for a delayed cholecystectomy compared with those who had an early procedure.

Compared with delayed or no cholecystectomy, an early procedure lowered the relative risk of a recurrent biliary event within 60 days by 92% (P < .001), and compared with no cholecystectomy, an early procedure lowered the risk by 87% (P < .001) and a delayed procedure lowered the risk by 88% (P < .001).

Patients who had no cholecystectomy also carried a 16-fold higher risk for death from a recurrent gallstone attack compared with patients who underwent the procedure (P < .001).

Huang and colleagues also found that low-volume facilities were less likely to perform early cholecystectomies, and that Hispanic and Asian patients, as well as those with Medicaid or no insurance, were significantly less likely to undergo cholecystectomy.

“It is a problem of poverty, access, and perhaps also a problem of communication and language,” Huang said. “Some members of minority populations might not speak English well enough to understand directions for follow-up. For some, cultural norms might make them afraid of the health care system or surgery.”

Finally, Huang and colleagues found that while delayed cholecystectomy performed on an outpatient basis was the most cost-effective strategy, it must be weighed against the risk for loss to follow-up, especially in patients from the at-risk groups mentioned above.

“We hope the findings of this study will lead to more awareness by physicians and policymakers of this gap in health care and the disparities by socioeconomic levels and ethnicity,” Huang said. – by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures.

A recent study showed that half of all patients with gallstone disease are not receiving timely cholecystectomy, which can increase their risk for subsequent complications.

Patients from certain disadvantaged ethnic and socioeconomic groups were particularly less likely to have their gallbladders removed after a gallstone attack, researchers noted.

“We didn’t suspect it was such a large portion of the population that wasn’t getting this relatively straightforward surgery,” Robert Huang, MD, MS, of the division of gastroenterology and hepatology at Stanford University Medical Center, said in an article on Stanford University School of Medicine’s blog, Scope. “We were surprised that only 50% of Americans (with gallstone disease) were receiving this surgery.”

To assess the effects of delayed cholecystectomy, Huang and colleagues reviewed data from ambulatory surgery, inpatient and emergency department databases from California, New York and Florida, and identified 4,516 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) after being hospitalized with choledocholithiasis between 2009 and 2014. Then they compared outcomes between patients who had early cholecystectomy at their index admission (41.2%), delayed elective cholecystectomy within 2 months of discharge (10.9%), or no cholecystectomy (48%).

They found that while both early and delayed cholecystectomy were comparably effective for reducing the risk for recurrent biliary events, patients had a 10-fold higher risk for a recurrent biliary event while waiting for a delayed cholecystectomy compared with those who had an early procedure.

Compared with delayed or no cholecystectomy, an early procedure lowered the relative risk of a recurrent biliary event within 60 days by 92% (P < .001), and compared with no cholecystectomy, an early procedure lowered the risk by 87% (P < .001) and a delayed procedure lowered the risk by 88% (P < .001).

Patients who had no cholecystectomy also carried a 16-fold higher risk for death from a recurrent gallstone attack compared with patients who underwent the procedure (P < .001).

Huang and colleagues also found that low-volume facilities were less likely to perform early cholecystectomies, and that Hispanic and Asian patients, as well as those with Medicaid or no insurance, were significantly less likely to undergo cholecystectomy.

“It is a problem of poverty, access, and perhaps also a problem of communication and language,” Huang said. “Some members of minority populations might not speak English well enough to understand directions for follow-up. For some, cultural norms might make them afraid of the health care system or surgery.”

Finally, Huang and colleagues found that while delayed cholecystectomy performed on an outpatient basis was the most cost-effective strategy, it must be weighed against the risk for loss to follow-up, especially in patients from the at-risk groups mentioned above.

“We hope the findings of this study will lead to more awareness by physicians and policymakers of this gap in health care and the disparities by socioeconomic levels and ethnicity,” Huang said. – by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures.