48 Audit on the Management of Patients Admitted with Acute Gallstone Disease

Abstract Aim To quantify the proportion of eligible patients admitted with acute gallstone disease receiving a cholecystectomy within 8 days at our hospital, using Chole-QuIC’s methodology. Method A retrospective audit was conducted on all patients admitted with acute gallstone disease to our district general hospital between 01/08/24-31/10/24 (n=119). Hot cholecystectomy candidates were identified using Chole-QuIC’s methodology. Additional data was collected for: surgery waiting times, starvation time (nil by mouth, NBM), length of stay, investigations and interventions. Data was analysed using GraphPad Prism. Results Out of 119 patients, 71.4% and 57.1% underwent CT and ultrasound scans respectively. 77/119 (64.7%) were acute cholecystitis (AC) patients, 7 of whom had percutaneous cholecystostomies. 40 AC patients were fit surgical candidates. 25/40 had inpatient cholecystectomies whilst 15 were discharged with outpatient cholecystectomies. AC patients with inpatient cholecystectomies had lower median surgery waiting times (3 vs 31 days, p< 0.0001). 5/15 discharged AC patients were re-admitted within 30-days. Median NBM days in AC patients was slightly higher in the inpatient cholecystectomies cohort compared to those discharged with outpatient cholecystectomies (2 vs 1 day, p=0.0204). Median admission length was higher in AC patients who had inpatient cholecystectomies (5 vs 3 days, p< 0.0071). Overall, 31/53 (58.5%) eligible acute gallstone disease patients received a cholecystectomy within 8 days. Conclusions There are significant challenges to meet the 8-day surgery rate of 80% targeted by Chole-QuIC in our unit. Inpatient cholecystectomies in the AC patients reduced surgery waiting times and prevented re-admissions but had drawbacks including longer fasting and admission duration.