Title : Improving waiting times to laparoscopic cholecystectomy in gallstone pancreatitis patients
Abstract:
Background: Management of Gallstone Pancreatitis includes addressing both the acute episode and the underlying cause. Laparoscopic Cholecystectomy (LC) should ideally be performed either during the index admission or within two weeks, after resolution. Early cholecystectomy reduces recurrence rates of pancreatitis, decreases readmissions, and shortens treatment course. Compliance with the recommended time-frame for LC varies. Delayed diagnosis, logistical issues, and patient factors all contribute to delays in surgery.
Methods: This study aims to assess the extent to which surgical practice complies with guidance, in the management of gallstone pancreatitis. We examined the timing of laparoscopic cholecystectomy in a cohort of patients, evaluating whether it was performed within the recommended window. Factors contributing to delays were identified, improved and then outcomes reassessed.
Results: Three simple interventions aimed at improving service provision, helped to improve compliance from 44 % (cycle 1) to 88 % (cycle 2). In cycle 1, 25% and 19% of patients underwent LC on index admission or within 2 weeks respectively (n=46). In cycle 2, 50% and 33% of patients underwent LC on index admission or within 2 weeks respectively. Patients missing in the outpatient setting also improved from 6, to 2. Readmission rates also significantly dropped in cycle 2 as compared to cycle 1.
Conclusion: The introduction of 3 interventions significantly improved timeframes to LC; 44% to 88%, ensuring timely LC in compliance with guidance. This also has the benefit of reducing readmission rates, reducing pancreatitis recurrence and shortening overall hospital treatment course.
