SP 7.07 Socioeconomic Deprivation and Laparoscopic Cholecystectomy in a Universal Healthcare System: Case Mix, Access and Outcomes from a Contemporary Scottish Biliary Service
Samantha Ng, Khurram Shahzad KhanAbstract
Introduction
Socioeconomic deprivation is linked to emergency presentation and poorer outcomes, but its effect on modern benign biliary pathways is uncertain. We assessed whether the Scottish Index of Multiple Deprivation (SIMD) relates to urgency and early outcomes after laparoscopic cholecystectomy (LC).
Methods
We performed a retrospective analysis of all LCs across three acute hospitals in one healthboard (January 2023–July 2024). SIMD decile (postcode-derived) was grouped as 1–3, 4–7, and 8–10. The primary outcome was elective versus non-elective surgery; secondary outcomes were 30-day readmission, post-operative imaging (CT/MRCP) or intervention (ERCP/IR drainage), major complications (Clavien–Dindo ≥III) and length of stay.
Results
794 patients underwent LC; 789 (99.4%) had valid SIMD data (mean age 51.2; 70.8% female). Non-elective surgery occurred in 44.8%, 37.0%, and 44.4% in SIMD 1–3, 4–7, and 8–10, respectively (p=0.096). Cholecystitis was more frequent in SIMD 1–3 (45.4%) than SIMD 8–10 (32.7%; p=0.032). Major complications (Clavien–Dindo ≥III) were 8.8%, 3.9%, and 4.6% (p=0.025). Readmission did not differ (6.5%, 7.9%, 8.5%; p=0.705), nor did any post-operative imaging/intervention (25.8%, 22.4%, 25.5%; p=0.568). ERCP/IR drainage was more common in SIMD 1–3 and 8–10 (12.1% and 13.1%) than SIMD 4–7 (6.1%; p=0.012).
Conclusion
Deprivation was associated with greater inflammatory presentation and higher crude major morbidity. After adjustment for biliary pathology and physiological risk, SIMD was not an independent predictor of urgency or short-term outcomes, suggesting broadly equitable early results once patients entered a consistent regional pathway.