65 Missed Opportunities: How Many Biliary Admissions Before Definitive Surgery?

Abstract Aim Cholecystectomy is the definitive treatment for symptomatic gallstone disease, with national and international guidelines strongly advocating surgery during the index admission. This study evaluates how frequently patients undergo multiple biliary admissions before receiving definitive surgical management. Method We conducted a single-centre prospective case series of all consecutive cholecystectomies performed by two biliary surgeons between August 2022 and June 2025. Both surgeons received referrals from two acute hospitals, with around 80% of patients initially managed by other teams. Electronic health records were reviewed to collect demographic data and quantify previous biliary admissions. Results If 319 patients identified, 19 were excluded for undergoing elective cholecystectomy without any prior biliary admission. Among the remaining 300 patients, 114 (38%) underwent emergency cholecystectomy. Median age was 54 years (IQR 38–65), and 193 (64.3%) were female. Intraoperative cholangiography was performed in 221 cases (73%), and 91 patients (30.3%) required bile duct exploration. Only 81 patients (27%) received index admission cholecystectomy. The rest had one or more prior admissions: 69 had one, 116 had two, 22 had three, 8 had four, and 4 patients had five or more presentations before surgery. Conclusions Despite robust guideline recommendations, index admission cholecystectomy remains significantly underutilised. Recurrent biliary admissions represent missed opportunities for timely, definitive care, leading to unnecessary morbidity, patient dissatisfaction, and increased system costs. Acute biliary services must be better prioritised, resourced, and integrated to ensure guideline-compliant care is delivered without delay.