29 Evaluating Adherence to NICE Guidelines for Urgent Laparoscopic Cholecystectomy in Acute Cholecystitis: A Clinical Audit

Abstract Aim To evaluate adherence to NICE guidelines recommending laparoscopic cholecystectomy within seven days of acute cholecystitis diagnosis, benchmarking against the Cholecystectomy Quality Improvement Collaborative (Chole-QuIC) national standards. Method A retrospective audit reviewed 257 consecutive laparoscopic cholecystectomies from January to March 2025, with 66 indicated for acute cholecystitis. Time from symptom onset to surgery was assessed against NICE standards (Warttig et al., BMJ, 2014). Results Of 66 cases, 18.2% (12/66) underwent surgery within seven days, and 21.2%. Only five cases were documented to have utilized the dedicated hot gallbladder pathway, with 40% (2/5) meeting the seven-day target. Average time to surgery was 68 days, with delays due to waiting lists, booking issues, delayed presentation, and associated comorbidity (analysis ongoing). Conclusions Adherence to NICE guidelines (18.2%) is below Chole-QuIC benchmarks, where top sites achieve 20–60% for surgery within 8 days. We are currently further analyzing reasons for delayed surgical intervention. Recommendations include optimizing the hot gallbladder pathway and improving communication to align with NICE and Chole-QuIC standards.