TPW 6.13 Timing of Cholecystectomy for Gallstone Disease in a District General Hospital: A Retrospective Audit of Guideline Compliance, Readmissions and Service Burden

Abstract

To assess compliance with guideline-recommended timing of cholecystectomy for patients admitted with acute cholecystitis and gallstone pancreatitis, and to evaluate the associated burden of gallstone disease, including readmissions, length of stay, and operative outcomes. A retrospective audit was conducted of adult patients admitted with gallstone-related disease between January and April 2025. Patients with acute cholecystitis or gallstone pancreatitis were included. An initial cohort was identified via a data extract, with individual case review performed using electronic patient records. Data collected included admission diagnosis, timing and type of cholecystectomy (emergency or elective), drain usage, length of stay, and readmissions. Time to surgery was calculated from admission to cholecystectomy. A total of 136 patients were included. Although 73 patients were deemed fit for surgery, only 11% underwent cholecystectomy within 10 days. Among patients awaiting elective surgery beyond 10 days, 13 of 28 (46%) experienced at least one readmission. Emergency surgery was associated with higher drain usage (approximately 75%) but favourable recovery, with a mean length of stay of 3 days (median 2 days) which is in line with the benchmark average for the trust of 3 days. Elective surgery had lower drain usage (approximately 25%) but was frequently preceded by recurrent admissions. Compliance with guideline-recommended early cholecystectomy was low. This led to preventable readmissions and increased healthcare utilisation. Emergency cholecystectomy appears safe and resource-efficient. Optimising acute gallbladder pathways and access to early surgery may improve outcomes and reduce service burden.