Association between repeated visits by patients with gallbladder disease and the probability of cholecystectomy

OBJECTIVES : Previous researches showed that there was substantial geographic variation in cholecystectomy rate, and that second opinion may reduce discretionary surgery. This study aimed to clarify if shopping around hospitals can act as second opinion and hence reduce discretionary surgery by investigating the association between the number of hospitals visited by patients with gallbladder-related disease and the probability of receiving cholecystectomy in a setting where patients have full autonomy in choosing physician without referral.

METHODS : Patients who had gallbladder-related diseases first diagnosed in 2009 and underwent cholecystectomy within 90 days were identified as surgery cases based on the Taiwan National Health Insurance (NHI) claims database. Those who had gallbladder-related diseases first diagnosed in 2009 and didn’t undergo cholecystectomy within 90 days were classified as the controls. The cases were matched in a 1:3 ratio with controls by a GMATCH algorithm. Matching variables included types of gallbladder-related disease, age, gender, and the date of first diagnosis. A logistic regression analysis was then applied to assess the association between the number of hospitals patients visited and the probability of cholecystectomy after controlling the number of total ambulatory care visits, the Charlson’s comorbidities index, and the level of the hospital at which the diagnosis was made.

RESULTS: There were 352 patients identified as surgery cases and 1102 patients classified as the controls. Regarding the number of hospitals visited within 90 days following the first diagnosis of a gallbladder-related disease, an increase of one hospital visited increased the odds of cholecystectomy by 2.8 times (odds ratio: 2.8; 95% confidence interval:2.22 -3.54). Concerning the number of visits for imaging test, an increase of one visit increased the odds of cholecystectomy by 1.14 times (odds ratio: 1.14; 95% confidence interval: 0.96 - 1.35) although non-significantly.

CONCLUSION: Patients’ repeatedly visiting physicians in different hospitals in Taiwan after gallbladder-related diagnoses been first made did not decrease the probability of cholecystectomy. The reason and motivation behind repeated visits warranted further studies to prevent unnecessary health care utilization.