Discharged ER Gallbladder Patients Often Require Emergency Surgery

Gallbladder disease is common in the U.S., and people suffering from it often find themselves in the emergency room to deal with the pain. Researchers recently concluded that a disturbing number of these patients are sent home only to return shortly for emergency surgery.

The study published in the Journal of Surgical Research found that 1 in 5 gallbladder patients seen in the ER, sent home and told to schedule surgery to remove their gallbladder find themselves back in the emergency department within a month.

As reported on AboutLawsuits.com, scientists from the Mayo Clinic in Rochester, Minn., reviewed billing records of more than 3,000 of their patients with abdominal pain from 2000 to 2013.

More than 1,600 were admitted for emergency gallbladder removal surgery (“cholecystectomy”), and about 1,500 patients were sent home after being instructed to schedule the procedure. Of those patients, 1 in 5 was back at the ER within a month, with an urgent need for the surgery.

More than half of the returning group was back within a week in need of emergency surgery.

That’s either a commentary on people who don’t follow medical advice, or, more likely, on medical advisors who should have recognized an urgent need the first time.

About 1 in 10 women and 1 in 15 men have gallstones, AboutLawsuits reports, and more than 1 million people are hospitalized in the U.S. for gallstone disease every year.

According to the National Institutes of Health (NIH ), risk factors for gallstones include:

  • Obesity. Obesity increases the amount of cholesterol in bile, which can cause stone formation.
  • Rapid weight loss. As the body breaks down fat during prolonged fasting and rapid weight loss, the liver secretes extra cholesterol into bile. Rapid weight loss also can prevent the gallbladder from emptying properly. Low-calorie diets and bariatric surgery (which limits the amount of food that can be digested) lead to rapid weight loss and increased risk of gallstones.
  • Diet. Diets high in calories and refined carbohydrates and low in fiber may increase the risk of gallstones. Refined carbohydrates are grains processed to remove bran and germ, which contain nutrients and fiber, such as white bread and white rice.
  • Certain intestinal diseases. Diseases that affect normal absorption of nutrients, such as Crohn’s disease, are associated with gallstones.
  • Metabolic syndrome, diabetes and insulin resistance. Metabolic syndrome, a group of traits and medical conditions linked to being overweight or obese that puts people at risk for heart disease and type 2 diabetes, also increases the risk of gallstone complications.

The gallbladder is a pear-shaped organ under your liver that stores bile, a fluid that helps the intestines digest fat. Bile is released through the bile duct connecting the gallbladder and liver to the small intestine. Problems arise if the bile duct is blocked by gallstones, which form when substances in bile harden. There are other gallbladder disorders, including cancer, but it’s fairly rare.

Often, gallbladder problems are resolved by removing the organ, which you can live without because bile has other ways of reaching the small intestine. For information about gall bladder surgery, see our backgrounder.

Demographics, rather than lab results, might be able to help determine who in the ER should get serious consideration for immediate surgery (or at least another immediate opinion), and who might be able to go home to make the surgical appointment. Of the study patients who were discharged, younger ones who were otherwise healthy and older patients who had other health problems were more likely to return to the ER than patients who were in their 40s and 50s.

When they analyzed the common indicators of gallbladder disease among the patients who returned to the ER, the researchers saw that some indicators (white blood cell count, temperature and heart rate) were no different from those of patients who left the ER and didn’t come back.

It can be tricky to determine who needs surgery immediately, and who can wait. But the rate of surgical complications rises significantly as the interval before surgery lengthens, especially if the delay between diagnosis and surgery is more than six days. If there are complications, or if surgery is performed on an emergency basis, patients are more likely to need open-abdomen gallbladder surgery instead of minimally invasive laparoscopic procedure. That involves a smaller incision, less chance for infection and a shorter recovery period.

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