When Early Cholecystectomy Outpaces Capacity: Post‐Decision Delay, Population Growth and Six Service Solutions From a Regional Australian Cohort Study

BACKGROUND: Early laparoscopic cholecystectomy is recommended for acute cholecystitis, yet delivery is often constrained by emergency theatre access. We examined whether delay occurred mainly before or after the decision to operate. METHODS: Retrospective single-centre cohort of adults undergoing emergency laparoscopic cholecystectomy for coded acute cholecystitis at Cairns Hospital (July 2021-June 2025). Primary outcomes were time to theatre, pathway decomposition, preoperative bed-days and cost. RESULTS: Among 122 patients, median preoperative wait was 2 days (IQR: 1-3) and preoperative waiting accounted for 260/482 bed-days (53.9%). The decision to operate was made on the admission day in 102 patients (83.6%), yet 29 (28.4%) still underwent surgery after > 2 days. Across recorded pathway intervals, 148/185 days (80.0%) accrued between decision and operation. In the same-day decision subgroup, waiting > 2 days was associated with similar postoperative length of stay (1 vs. 1 day, p = 0.496) and operative duration (108 vs. 112 min, p = 0.285), but longer total stay (5 vs. 3 days, p < 0.001). Weekend admission was associated with lower odds of delay > 2 days (OR: 0.20, 95% CI: 0.07-0.54). CONCLUSION: Delay appeared to represent post-booking inpatient queueing rather than delayed decision-making or clinically useful optimisation. The findings suggest a policy-capacity mismatch: early-surgery standards have expanded in a setting of population growth without matching resource allocation to theatre, ward and staffing capacity, a problem likely relevant to many Australian public hospitals.