HPB SO68 - Evaluating the Outcome of Laparoscopic Cholecystectomy Against Key Performance Indicator (KPI) of the British Benign Upper GI Surgical Society (BBUGSS)

Abstract Background Laparoscopic cholecystectomy (LC) presents inherent challenges and potential for significant complications, influenced by both patient factors and surgical expertise. Recognizing this variability, the British Benign Upper GI Surgical Society (BBUGSS) has established Key Performance Indicators (KPIs) aimed at enhancing LC outcomes. This study conducts an audit of LC outcomes in a single centre district general hospital (DGH) in accordance with BBUGSS KPIs and thus aims to determine if quality LC by modern standards is achievable in a DGH. Method The present retrospective observational study examined all adult LC conducted between August 2022 and June 2024 by two specialized biliary surgeons at a single surgical unit within a DGH, which also serves as a referral center of biliary cases from affiliated hospitals. The analysis encompassed preoperative assessments, intraoperative observations, and postoperative outcomes, with a focus on aligning these findings against the benchmarks established by the BBUGSS KPIs. Results 141 patients were included; median age was 54 years (IQR 41-64) and 59.6% were female. 37.6% were emergency cases, 44.2% were for acute cholecystitis, 22.7% for gallstone pancreatitis and 63.1% underwent intra-operative cholangiogram. KPIsBBUGSS StandardOur resultDay case for elective cases50%42%Readmission (within 30 days)<10%4.3%Laparoscopic cholecystectomy for acute cholecystitis (within 7 days)>35%97%Laparoscopic cholecystectomy for gallstone pancreatitis (within 2 weeks)>95%100%Conversion to open<5%0.7%Morbidity<10%1.4%Bile leak after elective surgery<1.5%0%Retained bile duct stones<2.5%0%Bile duct injury<0.3%0%Mortality<0.1%0% Conclusion This study shows that with the exception of day-case rate in elective LC, all KPIs were satisfactorily achieved, indicating that high quality LC is achievable within a DGH. The majority of readmissions within 30 days were related to inadequate postoperative analgesia. We have since enhanced pain management pathways. It is hoped that this will also improve same day discharge for elective cases to achieve BBGUGS standard. We are committed to conducting annual audits to monitor and optimize surgical outcomes and would encourage other centers to consider adopting the same approach.