92 Assessing the Impact of Benign Biliary Disease Referrals to a Tertiary HPB Centre

Abstract Background Centralisation aims to optimise resource utilisation and improve outcomes. However, the burden of benign biliary disease referrals to specialised centres remains unclear, complicating planning and resource allocation. Aim: To assess the impact of benign biliary disease referrals to a tertiary hepatopancreatobiliary (HPB) centre. Method A retrospective cohort study was conducted on 1,296 cholecystectomy cases between June 2023 and May 2025. Data were anonymised and extracted from patient records and the Patient Level Information and Cost System (PLICS), with cases categorised as either local or external based on postcode. Trends in case volume and referral reasons were analysed. Length of stay was compared between groups using two-sample t-tests (p<0.05). A cost analysis was performed to evaluate the financial implications. Results Of the 1,296 cholecystectomy cases, 1,164 (89.8%) were local and 132 (10.2%) were external. Case volume remained stable throughout the period. Only 25% of external cases were performed as day cases, compared to 60.4% of local cases. Both groups had similar costs for day cases. However, external inpatient cases incurred an additional average cost of £1,616.78 per case and accounted for 452 bed days. While the length of stay was comparable in male patients, female patients in the external cases group experienced significantly longer stays (p=0.023). Conclusions External referrals for cholecystectomy come with a cost pressure and increased demand for bed days. The findings highlight ongoing challenges in balancing resource allocation with patient outcomes and underscore the need to develop strategies that optimise efficiency and improve cost-effectiveness.