HPB P37 Sustaining and rebuilding a laparoscopic cholecystectomy service in the COVID and post-COVID era

Abstract

Abstract Background In the Belfast Trust (BHSCT), general surgery provision is complex- segregated into emergency and elective care, across multiple sites. The Emergency Surgical Unit (EmSU) provides ‘hot’ laparoscopic cholecystectomy (LC), and aside from a brief pause, continued throughout COVID. Elective LC was offered on another site in conjunction with the HPB service. This site became a COVID centre and surgical wards closed. Few cholecystectomies were performed during 2020/1. In an effort to restore provision, two ambulatory lists were established on the emergency site in December 2021. Subsequently, a regional ‘over-night stay’ unit opened on the original elective site in April 2023. Methods Previous BHSCT data demonstrated 300-350 elective LCs are undertaken annually with 66% as day cases. Since COVID, anecdotally significantly less LCs have been performed, and the length of stay (LOS) appeared greater. We performed a retrospective study looking at three time periods for comparison. “Pre-pandemic era” January 2019 to February 2020, “pandemic era” March 2020 to December 2021, and “pandemic recovery” from January 2022 to present. Patients were identified using the local HPB database and the electronic care record was reviewed for each patient. Information was gathered on demographics, day-case rate and LOS, as well as conversion and complication rates. Results In all, 827 patients have undergone cholecystectomy since the beginning of 2019. This is significantly less than the projected 1575, based on previous unit volume. Patient demographics are unchanged with mean age of 51.2 years, BMI of 30.27 and M:F ratio of 1:2.3. With the onset of the pandemic, we observed an increase in the average length of stay from 1.22 to 1.77 days with an associated fall in the day-case rate from 63.1% to 35.1%(figure 1). As demonstrated in figure 2, complication rates increased across the board and have been slow to fall in the recovery phase. Conclusions COVID decimated elective surgery globally. Locally, LC provision is an obvious example, with only urgent cases undertaken (76 in 2021 vs 363 in 2019). Unsurprisingly, conversion and complication rates increased. Despite attempts to reinstate the service, previous volume and outcomes have not been matched for multiple reasons. Increased time to surgery (waiting list >1600pts) means patients present with more severe disease. Ambulatory patients are nursed in EmSU where the environment is not orientated to rapid turnaround surgery. In addition, major losses of experienced nursing staff further impact theatre turnover and added to the challenge of setting up new elective facilities.