BN SO43 - The impact of dedicated “hot cholecystectomy lists” on rates of early cholecystectomy and its outcomes

Abstract Background Surgical management of gallstone disease is evolving with NICE guidelines emphasising on early cholecystectomy following an index admission with biliary symptoms. Despite an attempt at adhering to these recommendations, many centres find operating theatre capacity as a potential significant constraint to offer a same admission or early cholecystectomy. We assess the impact of a dedicated theatre capacity provided by a specialist upper gastrointestinal surgical team on rates of early cholecystectomy and its outcomes. Method A pathway for patients presenting with symptomatic gallstone disease was designed and implemented trust wide, with two theatre lists per week dedicated to performing “hot cholecystectomies”. Retrospective analysis was performed from a prospectively maintained database of patients with symptomatic gallstone disease admitted to a district general hospital over two equal (30 days) but chronologically independent time periods. Data was collected from prior and after service reconfiguration and analysed with descriptive statistics. Results 19 patients (F:M ratio 0.82:1) were referred for the consideration of receiving a hot cholecystectomy. Nine of the 12 patients (75%) who were deemed to be suitable as per NICE guidelines underwent a cholecystectomy within the recommended time frame. There was a significant difference in the number of admissions over the two time periods with a shorter time from index admission to surgery (median 62 days to 5 days (P<0.01)); with correspondingly fewer re-admissions from 14 to 2 (P<0.01) following service reconfiguration. Conclusion With adequate theatre resources together with surgical expertise, early laparoscopic cholecystectomy can be proved to be an effective and sustainable model for the management acute biliary disease. Continue ahead, we aim to improve our computer-based referral system which will be better suited to record referrals, and the patient pathway. This data will be developed into a dashboard, thereby keeping a contemporaneous record of acute admissions and their management; subsequently improving the number and quality of referrals.