Referral practices are associated with a delay in treatment of symptomatic cholelithiasis and cholecystitis

Lt Brittany Cook; Maj Rathnayaka M K D Gunasingha; Lt Sydney Dishman; Lt Megan Bartel; Cdr Matthew Bradley; Lcdr Carolyn Gosztyla

doi:10.1016/j.amjsurg.2023.09.041

Referral practices are associated with a delay in treatment of symptomatic cholelithiasis and cholecystitis

Am J Surg. 2024 Jan:227:96-99. doi: 10.1016/j.amjsurg.2023.09.041. Epub 2023 Oct 5.

Authors

Lt Brittany Cook¹, Maj Rathnayaka M K D Gunasingha², Lt Sydney Dishman³, Lt Megan Bartel², Cdr Matthew Bradley², Lcdr Carolyn Gosztyla⁴

Affiliations

¹ Uniformed Services University of the Health Sciences, 4301 Jones Bridge Ave, Bethesda, MD, 20814, USA; Department of Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA. Electronic address: Bhcook15@gmail.com.
² Uniformed Services University of the Health Sciences, 4301 Jones Bridge Ave, Bethesda, MD, 20814, USA; Department of Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA.
³ Department of Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA; Naval Medical Center Portsmouth Department of Aviation Medicine, Carrier Air Wing Three, USA; En Route and Critical Care Research Department, Naval Medical Research Center, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA.
⁴ Uniformed Services University of the Health Sciences, 4301 Jones Bridge Ave, Bethesda, MD, 20814, USA; Department of Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA; En Route and Critical Care Research Department, Naval Medical Research Center, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA.

PMID: 37806893
DOI: 10.1016/j.amjsurg.2023.09.041

Abstract

Background: The project was performed to determine if referrals to non-surgical providers after an initial presentation of symptomatic cholelithiasis are associated with a delay in surgical management.

Methods: A single institution chart review of all adult patients who underwent a cholecystectomy from 2015 to 2019 was completed. Quantitative data was analyzed using independent t-tests.

Results: Of 574 reviewed, 482 patients met criteria. Following initial presentation, 295 (61.2%) received a referral to surgery and 187 (38.8%) received follow up with a non-surgical provider. Those in the latter group had a significantly longer time from initial symptom presentation to surgical evaluation (65.7 days vs. 10.3 days, p < 0.001) and cholecystectomy (102.0 days vs 39.1 days, p < 0.001) when compared to the surgery referral group.

Conclusions: This study demonstrated that cholecystectomy was significantly delayed for patients who had been referred to non-surgical providers after initial presentation, prolonging symptoms and increasing use of healthcare resources.

Keywords: Biliary colic; Cholecystitis; Cholelithiasis; Referral.

Published by Elsevier Inc.

MeSH terms

Adult
Cholecystectomy
Cholecystectomy, Laparoscopic*
Cholecystitis* / surgery
Cholelithiasis* / diagnosis
Cholelithiasis* / surgery
Humans
Retrospective Studies
Time Factors
Time-to-Treatment