Rachel Wright
Introduction
Managing acute gallstone disease with cholecystectomy on the same admission provides safe and cost-effective patient care (NICE 2016). Despite this recommendation, the practice of early Laparoscopic cholecystectomy (ELC) in the UK has been very low compared to worldwide. Routine preoperative assessments are time-consuming, often lead to delays of operations, and add additional costs. Eliminating pre-assessment for fit and healthy patients (ASA I & II) will decrease the patient waiting list, reduce costs and streamline patient pathway without affecting patient outcomes.
Methods
This is a retrospective observational study that reviews all patients offered laparoscopic cholecystectomy via the hot gallbladder pathway at the University Hospital of North Tees and the University Hospital of Hartlepool from 2021 to 2024. Patient notes were reviewed to determine ASA grade at the time or surgery.
Results
Out of 511 patients offered laparoscopic cholecystectomy via the hot gallbladder pathway, 401 (78.5%) were classified as ASA I or II, and 110 (21.5%) as ASA III or IV. Within the ASA I/II group, 293 (73.06%) had their laparoscopic cholecystectomy without pre-assessment. There were no adverse outcomes observed in this group of patients. There was only one surgical cancellation, which was due to a non-anaesthetic reason.
Conclusion
For ASA I and II patients undergoing laparoscopic cholecystectomy, omitting routine pre-operative assessments will shorten surgical waiting time (2-4 weeks) without negatively impacting clinical outcomes and streamlining the hot gallbladder pathway.
Authors
Abdalla Hassan
University Hospital of North Tees, Stockton on Tees, United Kingdom
Rachel Wright
University Hospital of North Tees, Stockton on Tees, United Kingdom
Palanivelraju GOPALAKRISHNAN
University Hospital of North Tees, Stockton on Tees, United Kingdom
Valasubramaniam MAHADEVAN
University Hospital of North Tees, Stockton on Tees, United Kingdom