145 A Retrospective Review of Acute Biliary Pathology, Index Cholecystectomy and ERCP Rates in a Large DGH

Abstract Aim To assess overall management of acute biliary pathology in a large district general hospital, with particular focus on index cholecystectomy rate compared to national figures and the interplay with concurrent ERCP services in the hospital Method A retrospective review of all admissions with acute biliary pathology over a 2-year period (2022-2024), in a 500-bed DGH with 14 consultant surgeons. Number of admissions, index cholecystectomy rate, ERCP rate and length of stay (LOS) were some included criteria for assessment. Results There were 2564 emergency admissions with biliary pathology, with 1998 unique patients. 1615 patients had a single admission. 968 were female (59.9%), and overall median age was 66 years. Median LOS was 3.7 days. 733 had cholecystitis (45.4%) and 221 (13.7%) had CBD pathology. 175 (10.8%) had an index cholecystectomy, although 23.9% of patients with cholecystitis had surgery. 146 (9.04%) had an ERCP. Zero patients had ERCP followed by cholecystectomy on the same admission. 384 patients had multiple admissions. Median LOS was 2.9 days. 413 (43.5%) were with cholecystitis. 67 patients (17.5%) had a cholecystectomy and 59 (15.4%) had an ERCP during a repeat admission. Of patients who had an ERCP, 41 (69%) had a previous admission with biliary pathology. Conclusions Index cholecystectomy rates in this DGH were below national averages, despite the large size of both hospital and surgical department. The majority of patients who required an ERCP on repeat admission had been admitted previously with biliary pathology; given ERCP morbidity, there is clear motivation to increase index cholecystectomy rates to prevent this.