84 How Hot Is the Hot Gallbladder Pathway? Emergent Versus Delayed Laparoscopic Cholecystectomy - Lessons in Improving Access at One Large District General Hospital

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Abstract Aim This project aimed to evaluate the effect of the local hot gallbladder pathway (est. 2022, one session per week). We aimed to reduce waiting times, build a robust emergency pathway, and investigate barriers to progression. Aiming to align our service with national goals and produce a cost-benefit analysis. Method Large retrospective clinical audit, including all cholecystectomies performed between 2020-2024. Groups were compared by pathology, and whether managed electively or emergently. Data was collected on patient factors, waiting times, perioperative factors, outcomes and frequency of ED attendances. Odds ratios and 95% confidence intervals calculated for factors associated with outcomes of interest using binomial logistic regression. Results A total of 796 patients were included in analysis. Hot pathway patients saw waiting times drop (133 to 7 days) and benefited from 45-50% reduction in complication risk (OR 0.55 P 0.3). 34.6% of patients returned to ED with biliary issues more than once while awaiting surgery (P=0.05) and were 77% more likely to have a complication if they presented twice. Overall emergency cholecystectomy rate was 17.5% (UK average 16-26%). Conclusions Due to low capacity of the pathway, the study was underpowered. This audit led to the trust agreeing to double the capacity, but this remains insufficient when considering 30% of the emergency take relates to gallstone disease. Barriers to progression were primarily culture change, and NHS spending. With the global concern of antibiotic resistance pertaining to biliary sepsis, augmented by increasing prevalence of gallstone disease - there is a need for a national agenda to advocate for change.

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