Matt Spoor
Introduction
TRFT Model Health System data for Elective Laparoscopic Cholecystectomies (ELCs) from September to November 2025 showed a day case rate of 54.1% against a peer median 67.6% and BADS/GIRFT benchmark 75%. One month of ELCs were reviewed to identify the reasons for low day case rates and propose a local pathway to improve performance.
Methods
All ELCs in December 2025 were reviewed using electronic records and scanned anaesthetic charts. A guideline was then produced based on the BADS Day Case Laparoscopic Cholecystectomy booklet which was presented and agreed at department audit March 2026. Data will be reaudited in May against the guideline.
Results
ELCs in December n=25. Day case rate was 72% (admission n=7). n=5 planned: n=2 medical, n=1 surgical, n=2 scheduled last on list. n=2 unplanned, one due to nausea and one due to unexpected surgical difficulty. 76% not given non-steroidal anti-inflammatory drug (NSAID) premedication and 96% not given repeat paracetamol dose after initial premedication. 33% needed rescue antiemetic, becoming 45% with use of morphine intraoperatively. Patients spent less time on DSC ward the more antiemetics given (r=-0.30); and with higher total intraoperative opioid dose (r=-0.35).
Conclusion
Model health system data identified the need to improve the local ELC pathway. Review suggested that some standardisation of approach may improve day case rates: use of pre-medications, Fentanyl instead of morphine and appropriate scheduling. We intend to re-audit in May 2026 against the agreed guideline aiming for an improvement in day case rates and reduction in unplanned admissions.
Authors
Matthew Spoor, Kim Russon, Matthew Rigby
The Rotherham NHS Foundation Trust, Rotherham, United Kingdom