1162 Management of Acute Gallstone Disease at an Urban Acute Trust During the Pandemic – Closed-Loop Audit

Abstract

Abstract Aim Acute gallstone disease is a surgical emergency with emphasis on early surgery (Laparoscopic Cholecystectomy (LC)) to improve outcomes. Method Patients presenting with acute cholecystitis, biliary colic, and gallstone pancreatitis between September and December 2021 were retrospectively audited. We measured re-admission rates, emergency and elective cholecystectomies performed, and interval between operation and initial admission. This revealed a need for improvement in the service provided at this trust. An intervention was implemented with the Hot Cholecystectomy list being available for other surgeons as well as encouraging acute LC on the Emergency theatre list. A follow-up retrospective audit was carried out between July and September 2022 using the same criteria as per the initial data collection. Results 240 patients were admitted with acute gallstone disease during the initial audit period. At the end of audit period, 49 patients underwent LC, of which only 20% were performed acutely. However, 70% of acute operations were performed during re-admissions. During the re-audit, 109 patients were admitted with acute gallstone disease. Within the three months, 21% of patients underwent LC, out of which 52% were acute operations. 50% of the emergency operations were in re-admission patients. Patients from the initial audit were followed up which revealed average waiting time of 118.5 days from admission to LC Conclusions There was almost a 3-fold increase in the rate of Emergency LC post intervention. While there is an increase, provision of emergency cholecystectomies does not comply with national guidelines. Resources need to be allocated nationwide for timely treatment of acute gallstone disease.