HPB SO65 - An audit of the day-case rate of laparoscopic cholecystectomies at a busy district general hospital and factors affecting this

Abstract Background The target day case rate of laparoscopic cholecystectomies at a busy district general hospital is 75%, as per Model Hospital Guidelines. The current rate at which day cases are achieved is 55%. This audit aims to identify factors relating to the DGH not reaching their day case target and explore potential solutions for these, with the intention to reduce patient’s hospital stay and, therefore, overall costs. Method 119 patients had undergone a laparoscopic cholecystectomy in the first five months of 2024. Exclusion criteria included hot cholecystectomies, common bile duct explorations and planned admissions. The remaining 85 patients were included in this audit. The data proforma included age, ASA, BMI, co-morbidities, Nassar grade, scheduled and actual time of operation and any reasons for delay. Results Of the 85 patients included in this audit, 34% (29) were not daycases. 11 remained an inpatient due to post-operative nausea or pain, 3 due to requiring an MRCP, 9 were kept in for monitoring, 2 had intraoperative bleeding, 3 had social issues and 1 required IV antibiotics. 58% of the 29 had afternoon operations. 48% of the 29 had a Nassar grade of greater than 1. 38% of the 29 had a BMI greater than 30. Conclusion Various reasons for a case to not achieve daycase status were found, with the most common being post-operative pain or nausea. It would prove beneficial to educate patients on common post-operative symptoms and focus on managing these symptoms effectively. Pre-operative appointments should aim to explore a patients home setting at the time of the operation and ensure to book inpatient stays for those who require it, in advance. Theatre lists should be optimised by giving high-risk patients morning slots.