The spectrum and cost of complicated gallstone disease in California

Hypothesis: We hypothesized that complications of gallstone disease are mor e common than previously recognized and are related to treatment delay. Design: Retrospective review. Patients: Data for 248 consecutive patients from a university hospital in 1 995-1996 and 40571 patients identified through the 1996 California Office o f Statewide Health Planning and Development database who underwent cholecys tectomy for gallstone disease were reviewed. Main Outcome Measures: Diagnosis, length of hospital stay, hospital mortali ty, type of admission, type of surgical procedure, hospital cost, and inter val of delay between onset of initial symptoms, ultrasound diagnosis, and c holecystectomy. Results: The spectrum of gallstone disease included biliary colic in 56%, a cute cholecystitis in 36%, acute pancreatitis in 4%, choledocholithiasis in 3%, gallbladder cancer in 0.3%, and cholangitis in 0.2%. Community hospita ls, public or county hospitals, and academic health centers had a similar d istribution of diagnoses. Patients undergoing cholecystectomy for biliary c olic had a significantly shorter length of hospital stay, lower operative m ortality rate, were more likely to have their operations completed laparosc opically, and had lower hospital charges than patients undergoing cholecyst ectomy for complications such as acute cholecystitis. Over half of the pati ents requiring cholecystectomy for complications of gallstones initially pr esented with biliary colic. Patients with gallstone complications had an av erage delay from ultrasound confirmation to surgery of 6 months. Conclusion: Complications of gallstone disease are (1) common, (2) costly, and (3) potentially preventable.