Quicker Referral for Gallbladder Operation Could Save 50 Percent of Preoperative Treatment Charges

Quicker Referral for Gallbladder Operation Could Save 50 Percent of
Preoperative Treatment Charges

Delays contribute to unnecessary ER visits and additional imaging services

CHICAGO, Oct. 14 /PRNewswire-USNewswire/ -- Getting patients to the operating
room more quickly could cut by half the amount paid for hospital treatment of
painful gallstones, researchers reported today at the 2009 Clinical Congress
of the American College of Surgeons. According to a study of 383 patients who
underwent surgical treatment for gallstones at the University of North
Carolina in 2008, the average hospital charge of $5,292 could be reduced by 50
percent if patients had only two preoperative visits to primary care
physicians or the emergency department and one clinical imaging study.
Researchers found that patients on average had more than four visits to a
primary care physician, emergency department, or surgical clinic and nearly
three imaging studies, including ultrasound, computed tomography, or a nuclear
medicine scan of the liver, gallbladder, biliary tract, and small intestine,
from the time they first showed symptoms of gallbladder disease to the time of
the operation.

The researchers concluded that delays in obtaining surgical care of
symptomatic gall-stones resulted in unnecessary visits to the emergency
department for pain relief and additional diagnostic imaging. "I don't want to
say that physicians are managing gallbladder disease in the wrong way, but we
and other researchers are trying to find a better way, particularly in the
current climate of trying to improve the quality and reduce the cost of care.
As surgeons, we're hopeful that patients will be referred to us earlier and go
the OR sooner rather than come back for more visits and more imaging studies.
It just costs more money, and the patient has to go through more pain and
waiting in the emergency department. So once the diagnosis of symptomatic
gallstones has been made, we believe patients should see a surgeon who can
make the determination of when they need to go to the operating room. We also
think that if a patient has an imaging modality study that shows gallstones,
they don't need to have another one," explained Lindsee E. McPhail, MD, a
fellow in gastrointestinal surgery.

Findings from the study carry a message not only for primary care physicians
who refer patients to surgeons for treatment of gallstones but also for
patients. "When patients have a bout with gallstones, they often go to the
emergency room to get medications. When they feel better, they don't feel the
need to see a surgeon or have a follow-up. But then they end up having more
pain and come back to the emergency department. So the onus is on patients and
physicians as well to get this problem taken care of surgically as soon as
they can," she said.

The researchers reviewed every patient who had been surgically treated for
gallstones at the University of North Carolina (Chapel Hill) hospitals,
tabulated the number of times patients went to the emergency department or saw
their primary care physician as well as the number of imaging studies they had
prior to their operation, and added up the total hospital charges before they
underwent the procedure. The research team plans to extend the study to the
entire state of North Carolina. "This study was limited to UNC, so we did not
capture patients who were treated and had imaging studies at other hospitals.
We hope to get a much better picture of the management of gallbladder disease
using all the data from the state," Dr. McPhail said.

Blockage of the bile ducts by gallstones is the most common reason why
patients are hospitalized for severe abdominal pain. Because gallstones almost
never disappear spontaneously, they are treated most effectively by surgically
removing the gallbladder [cholecystectomy]. "I think most people know that if
they have symptomatic gallstones, the answer is to take out the gallbladder
surgically. We are hoping that the information from this study will show that
the management of gallbladder disease can be streamlined and that timely
surgical care is essential if we hope to contain costs," Dr. McPhail said.

Anthony G. Charles, MD, MPH, and George F. Sheldon, MD, FACS, participated in
the study, which was presented as a scientific exhibit at the ACS Clinical
Congress.

SOURCE American College of Surgeons

Sally Garneski, +1-312-202-5409, pressinquiry@facs.org or Laddavanh Vannavong,
+1-312-202-5329, pressinquiry@facs.org, both of the American College of
Surgeons