Gallbladder Surgery and When To Get It
Gallbladder surgery is performed one half million times in the United States every year. Many of these procedures are done on an emergency basis. But how do doctors know who needs immediate attention and who can wait to schedule gallbladder surgery?
Determining the correct answer to this question is important because the risk of complications rises for some individuals who wait for surgery. Although it is usually obvious which patients require emergency surgery, it can be a challenge to determine which individuals can wait and for how long.
In fact, according to the Mayo Clinic team that performed the latest study, a significant number of people who visited the emergency room complaining of gallbladder pain and who were released from the hospital with the goal of scheduling surgery at a later data returned to the emergency department within 30 days for immediate surgery. Therefore the question of how to determine who should get immediate surgery was the focus of a newly published study in the Journal of Surgical Research.
Gallbladder removal, or a cholecystectomy, is usually performed because gallstones have developed, the gallbladder is inflamed or infected (cholecystitis), or an individual has gallbladder cancer. Surgeons have two different methods to remove the gallbladder.
The preferred approach is laparoscopic, in which several small incisions are made and tiny video cameras attached to laparoscopes are used to help the surgeon see the gallbladder, which is removed through one incision. The open method involves a large (2 to 3 inches) incision.
The laparoscopic approach is less invasive and therefore carries a lower risk of infection and other complications. Recovery time is also shorter than for the open method. However, the latter approach is frequently necessary for people who have a severely diseased organ or if other complications are present.
In this study, the investigators evaluated the billing records of 3,138 patients at Mayo Clinic in Rochester who had visited the emergency department complaining of abdominal pain within 30 days before they had gallbladder surgery. Here are their findings:
- More than half (1,625) were admitted for emergency gallbladder surgery while the remaining 1,513 returned home and scheduled surgery for a later time.
- 20 percent of those who were allowed to go home returned to the emergency department within 30 days and needed an immediate cholecystectomy
- Of the 20 percent who returned for an emergency procedure, 55 percent came to the hospital for the surgery within one week of their initial visit
- The two populations most likely to return to the emergency department within the 30 days for urgent surgery were younger patients who were otherwise healthy and older adults who had other health issues
- To complicate matters, the investigators did not see any difference in tests (e.g., white blood cell count, heart rate, temperature) results between those who left the emergency department and did not return within 30 days and those who did return for urgent surgery
Healthcare cost is a huge topic of concern, and it is a consideration when looking at gallstones and gallbladder surgery. Emergency gallbladder surgery is more expensive than a scheduled procedure, yet delaying the procedure and then requiring organ removal more than six days later increases the chances of complications related to surgery and may make the more invasive procedure necessary, according to the authors.
Dr. Juliane Bingener-Casey, MD, the study’s co-author and a gastroenterologic surgeon at Mayo Clinic in Rochester, explained in a clinic statement that gallbladder disease is among the most expensive conditions in the United States. “If we can get that right [decision to operate] the first time, I think we can make things better for a lot of people.”
Unfortunately, the authors of this study were not able to answer the question posed at the beginning of this article. However, the data collected, plus further study, may help them reach that goal in the future. One thing patients can do that may help is to make sure they are as clear and comprehensive as possible about their lifestyle, medical history, drug use, and symptoms when talking to healthcare providers who will make the decision about gallbladder surgery.
For now, doctors are still trying to get gallbladder surgery right the first time as often as possible. The findings of this study and future research will hopefully make this a reality for more and more people.
Mayo Clinic Rochester