BN SO20 - Day-case laparoscopic cholecystectomy: Predictors of failure

Abstract Background Laparoscopic Cholecystectomy (LC) is the main treatment option for symptomatic gallstone disease. It is commonly performed as a day case operation and Getting It Right First Time (GIRFT) have suggested that this should be the default position for all trusts. NHSE Model Hospital analyses hospital metrics and sets national benchmarks. They suggest that the day case rate for LC should be greater than 71.4%. The aim of our study is to analyse all elective LC’s over a two year period and identify factors that increase the likelihood of day-case failure and the common reasons for this. Method All patients who had LC between 1st July 2020 and 30th June 2022 were identified. All emergency cholecystectomies were excluded from analysis. Patient and operative details were retrieved from their electronic record and a Charlson co-morbidity index was calculated. Statistical analysis was performed using SPSS with Chi-squared tests performed for categorical data and ANOVA for continuous data. Odds ratios with 95% confidence intervals were calculated. Statistical significance was taken as p<0.05. Results 788 patients had elective cholecystectomies with 74.0% being successful day-case. Factors increasing day-case failure included: Admission with gallbladder disease within past year (OR 3.15 (2.26-4.37), CBD diameter>8mm (OR 2.17(1.44-3.26), thick-walled gallbladder (OR 2.20(1.59-3.04), on-table cholangiogram (OR 4.16 (2.21-7.84), sub-total cholecystectomy (OR 30.6(9.19-102) and male sex (OR 1.55(1.11-2.18). Patients who failed day-case had higher mean age (59 vs 49) and higher co-morbidity index (2.16 vs 1.44). The most common reasons for day-case failure were complex procedure (41%), and symptom control (35%). Only 20% had planned admissions. 30-day morbidity and re-admission rate were higher for failed day-case patients. Conclusion Our hospital complies with the day case benchmark set out by Model Hospital. Furthermore, only 5.2% of patients undergoing elective cholecystectomy had a pre-operative decision for an inpatient stay demonstrating that day case is the default for the vast majority of patients. Despite this, improvement could still be made with post-operative symptom control to try and increase this number further.