The hot gall bladder audit: Evaluating adherence to NICE guidelines at a Tertiary NHS Trust

Title : The hot gall bladder audit: Evaluating adherence to NICE guidelines at a Tertiary NHS Trust

Abstract:

Background: Timely laparoscopic cholecystectomy for acute cholecystitis improves outcomes, with NICE guidelines recommending surgery within seven days of diagnosis. The Cholecystectomy Quality Improvement Collaborative (Chole-QuIC) has driven this trend, with some centres achieving ~80% adherence to urgent cholecystectomy within 7–8 days, highlighting pathway optimization potential.

Objectives: To assess adherence to NICE guidelines by measuring the percentage of “hot cholecystectomies” performed within seven days of symptomatic acute cholecystitis in our Trust.

Methods: A retrospective review examined 257 consecutive laparoscopic cholecystectomies from January to March 2025, with 77 indicated for acute cholecystitis. Time from symptom onset to surgery, and from listing for surgery to the actual operation date were compared against NICE standards (Warttig et al., BMJ, 2014).

Results: Of 77 cases, 2.6% (2/77) received surgery within seven days of symptoms., while 5.1% (4/77) underwent surgery within 7 days of being listed for surgery. Five cases used the dedicated hot gall bladder pathway, with 40% (2/5) meeting the one-week target. The median time to surgery was 55 days, with delays linked to waiting lists, booking miscommunication, delayed presentation, and concurrent pancreatitis/jaundice and other co-morbidities. 32 cases (41.5%) presented within the 7-day window and had no obvious delaying medical condition. Further insights into associated postoperative complications are being analysed to be presented as well.

Conclusions: Suboptimal adherence (2.6%) compared to Chole-QuIC benchmarks reflects pathway inefficiencies. Recommendations include optimizing the hot gall bladder pathway and improving communication to align with NICE standards.

Keywords: acute cholecystitis, laparoscopic cholecystectomy, NICE guideline, hot gall bladder, audit.

Biography:

Mohamed Ayyad is a general surgery registrar, he is currently developing his career within the NHS. He began his surgical training at Cairo University's National Cancer Institute, Egypt, where he completed a three-year residency and earned a Master’s degree in Surgical Oncology. He is now works as a specialty registrar in general surgery at University Hospitals, Birmingham NHS Foundation Trust. Mohamed is passionate about research, audit, and quality improvement, and is committed to expanding his portfolio with a focus on high-quality surgical training, professional development, and excellence in patient care.