Socially Vulnerable Patients are More Likely to Fail Outpatient Management of Symptomatic Cholelithiasis.

INTRODUCTION: Symptomatic cholelithiasis is a common surgical problem with many patients requiring multiple gallstone-related emergency department (ED) visits before undergoing cholecystectomy. Social Vulnerability Index (SVI) identifies vulnerable patient populations. We assessed the association between social vulnerability and outpatient management of symptomatic cholelithiasis.

METHODS: Patients with symptomatic cholelithiasis related ED-visits were identified within our health system from 2016 to 2022. Clinical outcomes data was merged with SVI census-track data, which comprises of 4 SVI subthemes (socioeconomic status, household characteristics, racial & ethnic minority status, and housing type & transportation). Multivariate analysis was used for statistical analysis.

RESULTS: 47,292 patients presented to the ED with symptomatic cholelithiasis, of which 6103 (13.3%) resided in vulnerable census-tract regions. Of these patients, 13,795 (29.2%) underwent immediate cholecystectomy with a mean time to surgery of 35.1hours, 8250 (17.4%) underwent elective cholecystectomy at a mean 40.6 days from the initial ED visit, and 2924 (6.2%) failed outpatient management and returned 1.26 times (range 1 to 11) to the ED with recurrent biliary-related pain. Multivariate analysis found social vulnerability subthemes of socioeconomic status (OR 1.29, 95% CI 1.09-1.52) and Racial & Ethnic minority status (OR 2.41, 95% CI 2.05-2.83) to be associated with failure of outpatient management of symptomatic cholelithiasis.

CONCLUSION: Socially vulnerable patients are more likely to return to the ED with symptomatic cholelithiasis. Policies to support this vulnerable population in the outpatient setting with timely follow-up and elective cholecystectomy can help reduce delays in care and overutilization of ED resources.