Introduction
The British Society of Gastroenterology guidelines recommend that patients with mild to moderate gallstone pancreatitis undergo cholecystectomy during their index admission or within two weeks to reduce the risk of recurrence. Recurrence rates occur at an average of six weeks post-admission so removing the gallbladder urgently minimises readmissions and improves patient outcomes. This audit examined the time taken from admission for gallstone pancreatitis to cholecystectomy.
Methods
A retrospective study was conducted on 48 patients admitted to the Royal Shrewsbury Hospital between February and May 2024 with mild to moderate gallstone pancreatitis. Inclusion criteria included patients with stones or sludge in the gallbladder or stones in the common bile duct. Mild to moderate pancreatitis was defined as the absence of peripancreatic collections, organ failure, or ITU admission, with symptomatic improvement.
Results
Of the 48 patients, 13 (27%) received cholecystectomy during the index admission, 9 (19%) had surgery after two weeks, and 26 (54%) were exempt from the guideline.
Conclusion
A significant number of patients did not receive cholecystectomy within the recommended two-week window, with many placed on a Priority List (PL2) indicating surgery within four weeks. This priority listing does not conform to the guideline, and it was recommended to revise the surgical prioritisation form to ensure a direct pathway for surgery within two weeks for these patients. A second loop of the audit will be conducted in the near future and will assess whether these changes improve the timing of cholecystectomy.
Authors
Thomas Hughes
Keele University School of Medicine, Stoke on Trent, United Kingdom
George Kirby
Royal Shrewsbury Hospital, Shrewsbury, United Kingdom