EP.TH.249Evaluating the incidence and predictors of readmission in patients awaiting cholecystectomy for previously diagnosed acute gallstone disease

Abstract

Abstract Background Recurrent hospital admission remains a major issue with patients awaiting surgery for symptomatic gallstones. We evaluated the incidence and predictors of readmission in patients previously admitted with acute gallstone disease. Patients and Method We analysed laparoscopic cholecystectomies performed between January 2018 and December 2019. Data relating to the acute index admissions, readmissions, waiting time to surgery, operative details including emergency, elective procedures and conversion rates were analysed. Results 532 procedures were performed over a two-year period. Patients with non-acute gallstones (111), primary open (4) and abandoned procedures (2) were excluded. Median age 415 included patients was 50(13-89) years and a male to female ratio of 1:3. Index admission presentations were acute cholecystitis (41.7%), biliary colic (23.1%), pancreatitis (15.9), obstructive jaundice (9.2%) and combinations (10.1%). 56.4% of the of the patients were readmitted between 1-6 times before surgery. Readmission diagnoses were cholecystitis (12.5%), biliary colic (26.7), pancreatitis (8.2%), obstructive jaundice (8.0%), acute cholecystitis with gallbladder perforation and abscess (0.5%), post-ERCP pancreatitis (0.5%) and pancreatic pseudocyst (0.2%). 14.9% of the patients underwent emergency procedures. Overall conversion rate was 1.4%. Median waiting time to surgery was 12(0-123) weeks. Waiting time to surgery was significantly lower in gallstone pancreatitis compared with other presentations (p-value 0.008). Acute pancreatitis (p-value 0.0001) and complicated index presentations (p-value 0.0001) were predictors of recurrent symptoms and readmission. Age, gender, comorbidities, high BMI, ASA have no significant impact on readmission episodes. Conclusion Readmission is a common occurrence following acute gallstone attacks with acute pancreatitis and complicated index presentations as significant predictors.