Enhancing Timing and Referral Pathways for Laparoscopic Cholecystectomy: A Two-Cycle Audit

Area of Science:

• Surgical Audit
• Healthcare Management
• Patient Outcomes

Background:

• Symptomatic gallstone disease necessitates laparoscopic cholecystectomy.
• National guidelines advocate surgery within 2-6 weeks to minimize complications.
• This audit evaluated adherence to local timing and referral guidelines for cholecystectomy.

Purpose of the Study:

• Assess adherence to local laparoscopic cholecystectomy guidelines.
• Evaluate the impact of service improvements on surgical timing and patient outcomes.
• Identify persistent barriers to timely surgical booking.

Main Methods:

• A two-cycle audit (July-August 2024, n=70; July-August 2025, n=50) was performed.
• Interventions included a structured pathway, teaching, and standardized booking.
• Key metrics: pre-assessment clinic (PAC) attendance, booking timeliness, follow-up avoidance, and readmission rates.

Main Results:

• PAC attendance increased from 3% to 16% post-intervention.
• Readmission rates decreased from 36% to 22%.
• Significant booking delays remained, with 36% scheduled at 3 months and 40% unbooked.

Conclusions:

• Service interventions improved PAC attendance and reduced readmissions.
• Surgical booking delays are the primary obstacle to timely laparoscopic cholecystectomy.
• Further pathway integration and addressing theatre capacity are crucial for guideline adherence.