208 Surgeon Led Selective Preassesment for Hot Gall Bladder and Its Outcomes in DGH Hospital

Abstract Aim According to NICE (2016), managing acute gallstone disease with cholecystectomy during the same hospital admission is safe and cost-effective. However, the rate of early laparoscopic cholecystectomy (ELC) in the UK remains low compared to global practice. Routine preoperative investigations can be time-consuming, expensive, and often cause unnecessary delays in surgery. Selectively omitting routine preoperative assessment for fit and healthy patients (ASA I and II), as categorised by surgeon, can enhance productivity, lower costs, and reduce waiting lists without compromising patient outcomes. Method This retrospective observational study, using prospectively collected data, examines patients who were offered laparoscopic cholecystectomy through the hot gallbladder pathway at the University Hospital of North Tees between 2020 and 2024. We analysed the subset of patients in this pathway who were ASA I and II, selectively categorised by surgeons and not preassessed. Result Of the 511 patients offered laparoscopic cholecystectomy via the hot gallbladder pathway, 401 (78.5%) were classified as ASA I or II. In this group, patients were not routinely preassessed, no surgeries were cancelled, and procedures were performed selectively without formal preoperative assessment. Importantly, there was only one surgical cancellation overall, which was unrelated to anaesthetic factors. Conclusions For medically fit patients undergoing laparoscopic cholecystectomy, eliminating routine preoperative assessments for a subset of patients categorised by surgeon could reduce costs, shorten waiting lists, and significantly improve day-case surgical practice without adversely affecting clinical outcomes.