Implementation of a Hot Gallbladder Service at a District General Hospital: A 15-Month Review

Background The National Institute for Health and Care Excellence, the Association of Upper Gastrointestinal Surgeons, and the Tokyo Guidelines advocate early laparoscopic cholecystectomy (LC) as the standard of care for patients presenting with acute cholecystitis (AC). This study evaluates the implementation of a hybrid Hot Gallbladder (HGB) pathway, incorporating both inpatient index admission and fast-tracked outpatient management at a district general hospital in the United Kingdom with a 550-bed capacity, analysing its impact on service efficiency, early surgery rates, and alignment with guideline standards. Methodology A retrospective review was performed over a 15-month period (January 2023 to March 2024) following the introduction of the HGB service. Patients presenting with acute biliary pathology were identified from the Surgical Acute Care Unit (SACU) database. Patients meeting the defined eligibility criteria were included. Data were cross-verified across the SACU database, the HGB service list, and electronic patient records to ensure accuracy before analysis. Patients were grouped into pre-HGB (n = 84) and post-HGB (n = 202) cohorts. Statistical analysis was performed using chi-square testing, with significance set at p-values <0.05. Results A total of 286 patients were included (80.4% female; mean age of 45 years). The most common diagnosis was biliary colic (62.2%), followed by AC (27.3%) and gallstone pancreatitis (10.5%). Introduction of the HGB pathway significantly increased the rate of early LC from 13.1% to 30.2% (χ² = 9.19; p = 0.0024). The complication and 30-day readmission rates remained low. Conclusions Implementation of a hybrid HGB service significantly facilitated early LC, nearly doubling the proportion of patients receiving early LC. Although performance improved further as the service matured, the verified overall increase from 13.1% to 30.2% represents the key finding. These results support the feasibility of guideline-aligned, structured HGB pathways within district general hospital settings and provide a foundation for prospective multi-centre validation.