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
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.