Title : Retrospective audit on the management of uncomplicated gallstone pancreatitis at MCHFT (Leighton Hospital)
Abstract:
Introduction: Most hospitals in the United Kingdom serving a population of 300,000-400,000 people admit about 100 cases of acute pancreatitis each year. It carries a wide spectrum of disease from mild (80%) to severe (20%) with prolonged hospital stay and risk of death. The commonest causes in western countries are gallstones (50%) and alcohol (25%). Abdominal ultrasonography should be performed to look for gallstones. After the index episode, recurrent gallstone pancreatitis attacks occur in up to 75% of patients with a mortality rate of 15%. Cholecystectomy provides the only definitive therapy, reducing recurrent biliary events to 2%. RCS guidelines state this should happen during the index admission or within 2 weeks of discharge.
Methods: Retrospective audit from January 2024 over 6 months. Relevant notes were sourced. We determined discharge dates, surgical listing means, pre-op assessment and cholecystectomy dates.
Results: There were 38 patients admitted with gallstone pancreatitis over the timeframe. Out of 27 patients who were candidates for surgery, only 1 patient met the national guideline. Mean wait from index discharge to pre-op assessment was 53 days. Mean wait from index discharge to cholecystectomy was 79 days. 7 patients required readmission with Gallstone Pancreatitis or Acute Cholecystitis prior to surgery.
Conclusion: There is a failure to meet national targets due to 2 main reasons. The lack of a dedicated 'Hot gallbladder listing form' and inadequate theatre booking form resulted in 16 out of 21 patients being inappropriately listed. There is an inadequate capacity of pre-op assessment clinics to meet demand.
