An Effective Approach to Improving Day-Case Rates following Laparoscopic Cholecystectomy

M G Clarke,T Wheatley,M Hill,G Werrett,G Sanders

doi:10.1155/2011/564587

Abstract

Background. Day-case laparoscopic cholecystectomy (LC) is a safe and cost-effective treatment for gallstones. In 2006, our institution recorded an 86% laparoscopic, 10% day-case, and 5% readmission rate. A gallbladder pathway was therefore introduced in 2007 with the aim of increasing daycase rates. Methods. Patients with symptomatic gallstones, proven on ultrasound, were referred to a specialist-led clinic. Those suitable for surgery were consented, preassessed, and provided with a choice of dates. All defaulted to day case unless deemed unsuitable due to comorbidity or social factors. Results. The number of cholecystectomies increased from 464 in 2006 to 578 in 2008. Day-case rates in 2006, 2007, 2008, and June 2009 were 10%, 20%, 30%, and 61%, respectively. Laparoscopic and readmission rates remained unchanged. Conversion rates for elective cholecystectomy fell from 6% in 2006 to 3% in 2009. Conclusions. Development of a gallbladder pathway increased day-case rates sixfold without an associated increase in conversion or readmission rates.

Highlights

In 2006, the NHS Institute for Innovation and Improvement, as part of the high volume Healthcare Resource Groups (HRG) program, produced a document entitled “Focus on Cholecystectomy” which aimed to improve both the quality and value of care for patients undergoing cholecystectomy [1]
This study aimed to examine the impact of introducing a new gallbladder pathway, based on the “Focus on Cholecystectomy” document, on the laparoscopic rate, conversion rate, day-case rate and readmission rate following cholecystectomy
A total of 1326 cholecystectomies were performed during the study period (Table 1). 1,130 (85.2 per cent) were performed as an elective and 196 (14.8 per cent) as an emergency procedure. 1,197 (90.2 per cent) were performed laparoscopically and 129 (9.8 per cent) were performed open. 62 (6.1 per cent) elective and 27 (14.5 per cent) emergency laparoscopic procedures were converted to open. 329 (32.5 per cent) elective cholecystectomies were performed as a day case, with an average readmission rate of 4.0 per cent

Summary

Introduction

In 2006, the NHS Institute for Innovation and Improvement, as part of the high volume Healthcare Resource Groups (HRG) program, produced a document entitled “Focus on Cholecystectomy” which aimed to improve both the quality and value of care for patients undergoing cholecystectomy [1]. This arose following an initial audit of 49,077 cholecystectomies, performed in England between April 2005 and 2006, in which a laparoscopic rate of 50 to 90 per cent and an average day-case rate of only 6.4 per cent was identified. Development of a gallbladder pathway increased day-case rates sixfold without an associated increase in conversion or readmission rates

Objectives

Methods

Results

Conclusion