EGS P01 Embracing a Paradigm Shift: A Single-Centre Experience with the Chole-QuiC Process

Abstract

Abstract Background Substantial evidence exists for the superiority ofemergency over delayed cholecystectomy for gallstone disease during primary admission. Despite this, emergency surgery rates in the United Kingdom remain low compared to other developed countries; with great variation in care across the nation. We aimed to describe the local paradigm shift towards emergency surgery and investigate outcomes. Methods A prospective observational study examining patients enrolled onto an emergency cholecystectomy pathway, following the hospital’s subscription to the Royal College of Surgeons of England’s Cholecystectomy Quality Improvement Collaborative (Chole-QuIC), between December 2021 and January 2023. Multivariate logistical regression models were used to identify patient and hospital factors associated with post-operative outcomes. Results 261/307 (85%) of all suitable acute admissions had an emergency cholecystectomy, compared to 5% the preceding four years. Waiting time dropped from 67 to 5 days. 208 (79.7%) patients were primary presentations. 92 (35.2%) were classed Tokyo grade 2 and 142 (54.4%) were obese. 23 (8.8%) patients underwent a preoperative ERCP and 26 (10%) of patients had a subtotal cholecystectomy. Favourable outcomes (Clavien Dindo ≥3) were observed in first presentations (OR 0.35p=0.042) and operation times within 7 days (OR 0.32 p=0.037); with worse outcomes in BMI ≥35 (OR 3.32 p=0.005) and operation time >7 days (OR 3.11 p=0.037). Conclusions A paradigm shift towards emergency cholecystectomy benefits both the patient and the service. Positive outcomes are apparent for early operation in patients presenting for the first time and recurrent attendees, with early operation (<7 days) providing the most favourable outcome in a select patient group.