HPB P56 Service Evaluation of Hot Gall bladder Pathway

Abstract

Abstract Background Management of acute cholecystitis has traditionally been conservative. Initially patients are treated with antibiotics posted for LC after 4-6 weeks.Surgery during acute settings was previously avoided due to fear of injuring surrounding structures. NICE guidelines published in October 2014 now advises that patients presenting with acute cholecystitis should have LC within a week which has been proven to be safe and effective. With respect to acute pancreatitis the standard of care should be lap chole during index admission for all non-severe cases. The purpose of this study is to evaluate the management of patients admitted with acute gall stone diseases. Methods It was a retrospective study of all the patients admitted with acute gall stone diseases and compare the outcomes after introduction of Hot Gall Bladder Pathway. We screened a total of 245 patients who had been included in this study between October 2018 to March 2020 with two groups: Data were collected form EZ Notes,IT Systems,Databases,Observations and Paper Records. Results Acute cholecystitis with no associated organ dysfunction who underwent Laparoscopic Cholecystectomy within week of diagnosis in the pre Hot GB List period was 43%(31/74) wheras in the Post Hot GB List period was 81% (93/116). Mild Acute Biliary Pancreatitis who underwent LC within index admission was 30% (5/17) in the preHot GB List Period wheras 78%(14/19) of patients with gall stone pancreatitis under went LC during the same admission after the beginning of Hot GB lists. Conclusions We had achieved almost 81% of the expected outcome in surgically dealing with patients presenting with acute cholecystitis and 78% with patients presenting with gall stone pancreatitis after introduction of Hot Gall bladder pathway. Safe and cost-effective hot gall bladder service can be provided by the EGS with input from upper GI surgeons with acceptable morbidity and a satisfactory outcome. Hot gall bladder pathway has proven to be effective in treatment of GS related diseases without significant increase in complication rate. It also helps avoiding readmissions, Gall stone related complications, reduces bed occupancy and improves patients’ quality of life.