AB102. SOH25_AB_273. Optimizing a ‘hot gallbladder service’: an audit from University Hospital Waterford 2023–2024

Background: Acute cholecystectomy remains a gold-standard treatment for managing acute biliary issues to prevent recurrent symptoms and complications. Early laparoscopic cholecystectomy should be the standard of care when possible, even in subgroups who are considered frail. Timing of acute cholecystectomy can vary pending access to an emergency list and local expertise. This audit was performed to assess the impact of an additional surgeon on the delivery of a ‘hot gallbladder’ service.

Methods: Electronic data was retrieved from surgical sign-outs and cross checked with NIMIS. Ultrasound, computerised tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) reports with a diagnosis of acute cholecystitis, biliary colic, choledocholithiasis and gallstone pancreatitis from Jan 2023 to October 2024. Other data collated included basic demographics, number of presentations, histology reports, post-operative length of stay (LOS) and complications.

Results: In total, 295 patients were admitted with imaging confirmed biliary issues. Of 168 patients admitted from Jan. 2023 to Dec. 2023, 11 (6.5%) underwent laparoscopic cholecystectomy within 10 days of admission. Of 127 patients admitted from Jan 2024–October 2024, 36 (28.3%) underwent laparoscopic cholecystectomy within 10 days of admission. Within the operative group, there were no conversions, no bile leak and no bile duct injuries.

Conclusions: There has been a marked increase in the delivery of a hot gallbladder service through an increase in surgical manpower as well as support from management, anaesthesia and nursing colleagues in access to the emergency list. By benchmarking current practices against international standards, the promising change shown in the numbers of ‘hot gallbladder’ surgery from 6.5% in 2023 to 28.3% in 2024 is directly related to surgical expertise and collaboration present in the unit. Additionally, the practice provides actionable insights to enhance clinical pathways, reduce delays in surgical intervention and improve patient outcomes.

Keywords: Gallbladder; benchmarking; hot, acute