FTP5.8 Gall bladder service developments to improve outcomes based on national guidelines

Abstract

Abstract Introduction Nationally, acute gallstone disease accounts for over 1/3rd of emergency general surgery admissions and referrals. Guidelines recommend laparoscopic cholecystectomy within 1 week for acute cholecystitis, on index admission for acute gallstone pancreatitis and within 18 weeks for uncomplicated gallstone disease. Presently, NHS Trusts struggle to meet these targets due to unrelenting demand for limited resources. We present interventions to improve a laparoscopic cholecystectomy service which nearly halved the elective surgery waiting time. Method Retrospective data was collected on patients who underwent elective laparoscopic cholecystectomy at a DGH pre- and post-intervention (March-July 2021 & January-April 2022). Data collected from electronic medical records included patient demographics, waiting list times, operation details and post-operative outcomes. Interventions included introduction of a boarding card which included Cholecystectomy As A Day-case (CAAD) scoring and laparoscopic cholecystectomy standard operating procedure (SOP). The SOP specified criteria for preoperative investigations, theatre list organisation, post-operative admission and high-risk patients requiring specialist surgeon input. Results Pre-intervention cycle included 82 patients, with 78 patients booked as day-case operations and 40.2% unplanned postoperative admissions rate. The post-intervention period assessed 72 patients, with 46 patients booked as day-cases and 30.6% unplanned postoperative admissions. The median day-case LOS remained at 0 days pre- and post-intervention. Median elective laparoscopic cholecystectomy waiting time significantly decreased from 140 to 75 days (p< 0.0001). Conclusion Our study demonstrates interventions to restructure a laparoscopic cholecystectomy service significantly shortened waiting times, with national targets of 18-week wait for uncomplicated gallstone disease surgery met. Additionally, fewer unplanned postoperative admissions allows better bed management therefore reducing disruption to elective and emergency service delivery.