Rural patients with a serious form of gallstone disease are less likely than urban patients to receive treatment
When gallstones are caught in the common bile duct that carries bile (that helps digest fats) from the liver to the gallbladder, it can cause potentially life-threatening complications such as inflammation of the pancreas and infection of the common bile duct. Rural patients with this type of gallstone disease, choledocholithiasis (CDL), are less likely to receive treatment than their urban counterparts, and are more likely to undergo more invasive open surgery rather than endoscopic surgery, reveals a new study.
Treatment choices (endoscopic, surgical, percutaneous) may differ, based on disease severity and presentation and availability of resources and personnel. The researchers examined the records of 111,021 hospital discharges for patients with CDL. They found that 81 percent of patients lived in urban areas and 19 percent in rural areas. Of these patients, 61 percent had uncomplicated CDL and 39 percent complicated CDL. No difference was found in the proportion of urban-rural patients with complicated CDL. However, urban patients were more likely to undergo intervention, which tended to be endoscopic.
A possible explanation may be that physicians and patients in rural settings are less likely to have endoscopic procedures available to them. Rural patients also received a higher proportion of elective procedures than urban patients (35 percent vs. 17 percent). The researchers suggest that rural facilities may not have available staffing to provide emergency procedures. This study was supported by the Agency for Healthcare Research and Quality (T32 HS13853).
See "An urban-rural blight? Choledocholithiasis presentation and treatment," by Julia Shelton, M.D., Kristy Kummerow, M.D., Sharon Phillips, M.S.P.H., and others in the Journal of Surgical Research 173, pp. 193-197, 2012.