WP7.14 - The change of a DGH emergency surgical service leads to marked improvements in timing of cholecystectomy for gallstone pancreatitis, in line with international guidance

Abstract Background International Association of Pancreatology (IAP) guidelines recommend that cholecystectomy should be performed on patients with mild biliary pancreatitis during their index admission. This retrospective study compares how a paradigm shift in the provision of emergency surgical services in one district general hospital (DGH) significantly improved ability to follow this guideline. With input from the surgical ambulatory emergency care network (SAEC), our team transformed care via an Emergency Surgery Unit (EmSU) system. This includes surgical assessment with ambulation, linked radiology slots, semi-emergency theatre lists twice weekly in addition to NCEPOD theatre and the emergency take divided in two according to sex of patient ensuring appropriate patient load for each of the surgeons of the week. Methods A retrospective study of patients with mild biliary pancreatitis for three years before (n = 107) and after (n=108) the EmSU system. Cholecystectomy on index admission was recorded, as was overall time to surgery (days). Data was analysed using GraphPad Prism Version 9.5.1. Data is expressed as Mean + SEM. Percentages underwent Arcsine transformation prior to inferential analysis. Groups of data were analysed using Students T-Tests. Results The percentage of patients operated on index admission increased 13.1-fold (4.8% to 62.9%; P < 0.01). Days to surgery saw a 10.1-fold reduction (332.5 + 41.1 to 32.9 + 6.3 days; P < 0.0001). Conclusions Adoption of our EmSU system has drastically improved care for patients with gallstone pancreatitis, now closer to best practice guidance. Further improvement is likely with increased buy-in from all members of staff.