TPTh 9.09 Audit of the Timing of Cholecystectomy in Gallstone-Induced Pancreatitis: Adherence to Guidelines and Impact on Patient Outcomes

Abstract

Gallstone-induced pancreatitis (GIP) is a major cause of surgical admissions in the UK. Early cholecystectomy, ideally during index admission or two weeks following discharge, is recommended by national guidelines to prevent recurrent biliary events. To assess adherence to these guidelines at University Hospital Monklands (UHM) and evaluate the clinical impact of delayed cholecystectomy. Retrospective data collection was conducted for patients admitted with gallstone-induced pancreatitis between September 2023 and September 2024. Data were retrieved under Caldicott approval. Exclusion criteria included severe pancreatitis, frailty, and refusal. Outcomes measured: timing of cholecystectomy, readmission rate, and time to intervention. A re-audit (Jan–Jun 2025) followed the pathway implementation. First Cycle: Of 69 total cases, 8 were excluded; 2 deaths; 59 eligible. Procedures performed: 30 (50.8%), timely procedures: 9 (15.2%), mean delay 11.2 weeks. Nineteen (32%) readmitted, 10 with recurrent GIP. Second Cycle: 41 admissions, 11 excluded; 30 eligible. 15 operated (50%), 13 (43%) timely—12 during index admission, 1 within 2 weeks post-discharge. Compliance improved following the expedited cholecystectomy pathway and live tracker introduction. The audit identified poor adherence to guidelines in the first cycle, with significant readmission and recurrence rates. Root causes included lack of structured follow-up, delays in anaesthetic clearance, and limited theatre availability. Implementation of expedited pathway and live tracker improved outcomes. Further gains depend on multidisciplinary cooperation and sustained monitoring. Performing cholecystectomy during index admission for mild gallstone pancreatitis reduces readmission and complications. Structured pathways and real-time Tracking enhances adherence to standards. Continued re-audit recommended.