43 Burden of Biliary Pathologies on Emergency Surgical Admissions

Abstract Aim Increasing hospital admissions are straining the healthcare system, and the pattern of acute surgical admissions post-COVID-19 have not been described. We aimed to determine the common surgical pathologies leading to acute surgical admissions, including patient demographics, length of stay (LoS) and intervention rates. Method We conducted a retrospective review of all acute general surgical admissions between January 1st and March 31st 2024 at a busy city teaching hospital serving over 500,000 people, identified from surgical handover documents. Variables analysed included route of admission, patient demographics, LoS, final diagnosis and intervention rates. Results A total of 1402 patients accounted for 1515 admissions, with a median of 17 admissions per day. Admissions were primarily from A&E (59%) and GP (35%) referrals. Upper GI pathologies contributed to 490 admissions (32.3%), including benign biliary (16%, n=243), benign pancreatic (6.7%, n=102), benign oesophageal (4.4%, n=66), malignant oesophageal (2.6%, n=39), malignant pancreatic (1.4%, n=21), and malignant biliary (1.3%, n=19). Median LoS was 6 days for biliary, 7 days for pancreatic and 3 days for oesophageal benign conditions. Surgical intervention was required in 22.2%, 7.8% and 18.2% of these cases, respectively. Conclusions Benign biliary disease now constitutes the primary burden in emergency general surgical admissions, likely reflecting the increasing incidence coupled by elective surgery backlog. A dedicated emergency biliary service alongside the emergency general surgery service provides a potential solution to meet demands by facilitating timely intervention. However, this will require restructuring of service due to current variation in availability of facilities and skills amongst different units.