EP 368 Evaluating Missed Opportunities for Emergency Laparoscopic Cholecystectomy: A Retrospective Single-Centre Audit
Danny Nguyen, Joussi Ramzi, Halil Hussein, Rachel AguiloAbstract
Aims
Emergency laparoscopic cholecystectomy (LC) for acute biliary pathology is associated with reduced hospital admissions, earlier definitive treatment, and reduced healthcare costs. This audit reviewed LC pathways at a single UK centre, examining delays to surgery, repeated booking attempts, adherence to priority (P-status) timeframes, and missed opportunities for emergency cholecystectomy.
Methods
A retrospective audit was performed of all patients undergoing LC at a single UK centre between January and December 2024. Electronic patient records were reviewed. Data collected included booking requests, urgency of surgery, P-status, time on waiting list, number of clinical interactions between booking and surgery, and suitability for earlier emergency cholecystectomy. Data were analysed using Microsoft Excel.
Results
191 cholecystectomies were included. 79 patients (41%) had multiple booking requests (range 2-5). Of these, 11 were emergency admissions, with 7 initially listed as elective. P-status timeframe adherence was low, with only 3 patients undergoing surgery within P2 targets; most patients progressed to later priority categories before operation. 89 patients (47%) proceeded directly to surgery following booking. 52 patients (27%) were identified as potentially suitable for earlier emergency cholecystectomy, with documented deferral reasons for 8 cases.
Conclusions
This audit demonstrates delays to LC, frequent repeated booking requests, and low compliance with priority-based timeframes. Contributing factors identified included prolonged waiting times, disease progression during admissions, emergency operating capacity, ERCP timing, and patients being lost to follow-up. Defined elective and emergency cholecystectomy pathways, clearer referral processes from emergency presentations, and improved emergency theatre access were identified as measures to address these findings.