FTP6.5 A review of a District General Hospital's performance in meeting Emergency Cholecystectomy guidelines
Charles Gallagher, Mohammed Dwebi, Barry McAree- Surgery
Abstract
Aims
Due the Covid pandemic and resultant decrease in elective cholecystectomies there has been an increase in the emergency presentation of gallstone disease to our DGH. The NICE guidelines recommend >25% of Acute Cholecystitis (AC) should receive emergency cholecystectomy on admission and the AUGIS Commissioning Guide: Gallstone Disease 2016 recommends all patients with mild Gallstone Pancreatitis should have an emergency cholecystectomy on admission or within two weeks of discharge. We wanted to see was our department meeting these guidelines.
Methods
187 patients identified with AC and pancreatitis from admission records over a three month period. Review of online records narrowed this down to 53 patients with AC (without secondary complications i.e. perforation, Mirizzi) and 18 with Gallstone Pancreatitis. We followed these patients up over a six month period.
Results
AC patients: 28% (15) were deemed high risk or not suitable (13: >75yo), 26% (14) emergency cholecystectomy on admission, 23% (12) awaiting clinic/ pre-assessment, 7.5% (4) Elective surgery (3 had readmissions pre elective surgery), 7.5% (4) surgery on readmission, 7.5% (4) opted out of surgery. Separately, 24.5% (13) readmitted with gallstone disease.
Gallstone Pancreatitis
44% (8) deemed not suitable (4: >85yo, 4: multiple co-morbidities), 33.3% (6) emergency cholecystectomy on admission and 1 each: severe pancreatitis/ opted out/ done on readmission (2.5months later)/ done privately.
Conclusions
Our DGH is hitting the target for emergency cholecystectomies although the majority of patients presenting with AC are not suitable for surgery and there is a high readmission rate for gallstone disease. Improvement required in following up patients with gallstone pancreatitis not receiving surgery on admission.