178 Challenges of Facilitating Early Cholecystectomy Through an Emergency Surgery Ambulatory Care (ESAC) Pathway: A Single-Centre Experience

Abstract Aim An emergency surgery ambulatory care (ESAC) pathway can be adopted to facilitate early laparoscopic cholecystectomy (LC) for acute cholecystitis and gallstone pancreatitis. Common challenges to achieving early intervention include high workload, limited theatre resources and unexpected post-operative admissions. This study aims to report our experience in performing LC through a dedicated ESAC pathway in a single district general hospital. Method Data was collected retrospectively on ESAC patients undergoing LC consecutively from 11/06/2024- 31/12/2024. Patients who were admitted post-operatively were compared to those discharged the same day. Patient characteristics including pre-operative diagnosis, presence of biliary obstruction and operative complexity (Nassar scale 3 or 4) were compared using Fisher exact test. Results 75 patients were included. 42 (56.0%) underwent LC for acute cholecystitis, 12 (16.0%) for acute pancreatitis and 21 (28.0%) for biliary colic. The median time from presentation to surgery was 62.3 (IQR 42-67) days. One patient (1.3%) underwent LC within 7 days of presentation. 24 patients (32.0%) were admitted for ≥1 night in hospital. Patients who had unplanned inpatient admissions were more likely to have gallbladder thickening on ultrasound preoperatively [20 (39.2%) vs 16 (66.7%), p=0.0464] and had more challenging procedures (Nassar scale 3 or 4) [15 (62.5%) vs 3(5.8%), p≤0.00001]. 4 patients (5.3%) were readmitted within 30 days due to complications. Conclusions A dedicated ESAC pathway for LC can ensure shorter waiting times for ambulatory patients with acute gallstone disease, however, facilitating early cholecystectomy remains challenging. A large proportion of patients require unplanned inpatient stay due to operative complexity.