WP7.9 - Evaluation of outcomes of early laparoscopic cholecystectomy for acute gallstone disease using Traffic Light Booking system

Abstract Introduction Delayed cholecystectomy leads to recurrent admissions with potential increased preoperative, operative, and postoperative complications. Aim To evaluate the outcomes of early laparoscopic cholecystectomy using traffic light booking system. Methods A quality improvement early gallbladder service was designed using the weighted scores of patients’ demographics, BMI, comorbidities, LFTs, imaging findings, confirmed diagnosis and associated gallstone complications. The scores were stratified into traffic light system colours of green (0-3), amber (4-6) and red (>7) to predict the operative difficulty and allocated operative time. Early cholecystectomy was performed within 6 weeks of the onset of symptoms. Operative difficulty grading use was by Nassar et al. Prospectively data was analysed using SPSS to present the outcomes. Results 207 patients had early cholecystectomy from February 2022 to January 2024. Median age was 50.5 years and 71.5% were females. Diagnoses were 60 biliary colic, 102 acute cholecystitis, 41 pancreatitis and 4 cholecystitis with biliary obstruction. Traffic light scores were 114 green, 76 amber and 17 red while operative difficulty grading was 44 mild, 73 moderate, 54 severe and 36 extreme difficulties. Median time to surgery was 21 (21-42) days and median operative time was 75 (25-205) minutes. 13.5% of the patients were operated at the index admission, 67.1% as day cases, 20.3% stayed overnight and 12.6% as inpatient stays. None were converted to open but four procedures were abandoned. Complication and readmission rates were 4.8% and 5.3% respectively with one patient returning to theatre. Conclusion Early laparoscopic cholecystectomy service can be safely delivered with the majority done as day cases.