Peri-operative emergency department utilization in inpatient and outpatient Medicare laparoscopic cholecystectomy.

Background: Preoperative emergency department (ED) visits may reflect the patient's biliary disease, or may signal unstable comorbid conditions that have relevance following inpatient laparoscopic cholecystectomy (ILC) and outpatient laparoscopic cholecystectomy (OLC) in Medicare patients.

Methods: We used the Medicare inpatient and outpatient Limited Datasets to identify elective laparoscopic cholecystectomy patients from 2011 to 2014. ED visits for 30-days before the surgical event were identified and correlated with the probability of patients returning to the ED in the 30-days following the procedure.

Results: A total of 129,377 inpatient and 235,339 outpatient LCs were identified. A total of 20,021 (15.5%) of ILCs and 52,025 (22.1%) of OLCs had 30-day preoperative ED visits. ILCs with any 30-day ED visit preoperatively had an Odds Ratio (OR) that predicted a post-discharge ED visit of 1.85 (95% CI = 1.78-1.92; P < 0.0001). OLCs with any 30-day ED visit preoperatively had an OR for post-discharge ED visit of 1.50 (95% CI = 1.46-1.54; P < 0.0001).

Conclusion: Preoperative ED visits predict postdischarge ED visits for laparoscopic cholecystectomy in Medicare patients.