FTP5.9 A review of post-operative outcomes following Cholecystectomy - Emergency vs Elective

Abstract

Abstract Aim NICE (CG188) 2014 recommends index cholecystectomy (IC) for patients admitted with gallstone disease, particularly “acute cholecystitis”, within one week of diagnosis. Conversely, elective cholecystectomy (EC) patients are pooled via various pathways, from elective to emergency. Safety of ICs is well-established. A study was conducted to investigate difference in outcomes between IC and EC. Methods Retrospective study of prospective database of cholecystectomies performed as primary procedure was carried out between February 2021 and July 2022 in our trust. The primary outcome was hospital readmission, while secondary outcomes included postoperative complications graded by Clavien-Dindo classification (CDC), length of stay (LoS) and intensive care (ICU) admission. Categorical and continuous data were analysed using Chi-Square and Mann-Whitney-U tests respectively. P-value <0.05 was statistically significant. Results 202 patients underwent cholecystectomy. There were similar numbers in the studied groups; IC-49.8% (n=100/202) and EC-50.2% (n=102/202). Hospital readmission rates were higher in the IC – 11/100(11%) vs EC – 3/102(2.9%), p=0.02. Postoperative interventions (grade-3-CDC) (IC-11.0%, n=11 vs EC-2.9%, n=3, p=0.02) and ICU admission rates (IC-7.0%, n=7 vs EC-1.0%, n=1, p=0.03) were higher in IC compared to EC. Uncomplicated recovery (grade-1-CDC) was significantly higher in EC (p<0.0001). Postoperative LoS was significantly longer in IC (p<0.0001). There was no recorded mortality in either group. Conclusion Study confirms that IC is safe. However, postoperative procedural interventions were more common in IC, which is highly indicative of complex pathology (perforated/necrotic gallbladder/inflamed hepatocystic triangle) and may be contributed by timing of procedure. Further studies to assess underlying factors contributing to these outcomes are warranted.