TTP4.12 Impact of Sub-Specialization on Outcomes Following Benign Biliary Surgery

Abstract Aim : Gallstone disease accounts for over one third of all acute surgical admission. Outcomes of benign biliary surgery can vary widely due to patient and surgeon related factors. We hypothesize that subspecialization plays a key role in improving surgical outcomes for benign biliary conditions in elective and emergency setting. Methods This multicentre retrospective study included all consecutive adult patients undergoing elective and emergency cholecystectomy at three hospitals from August 2023 to July 2024. The health board has over 30 general surgeons, including two biliary specialists handling complex cases. Data collected included patient demographics, operative details, and postoperative outcomes, including readmission rates. Patients were categorized based on whether biliary or non-biliary surgeons performed the surgery and outcomes were compared. Results 564 patients were identified, median age was 53 years and 404 (71.6%) were female. 125 (22.2%) cholecystectomies were preformed by biliary surgeon and 439 (77.8%) by non-biliary surgeon. Biliary surgeon preformed more emergency cases (44.8% vs 35.1%, p=0.047), more intra-operative cholangiogram (84% vs 24.4%, p0.001) and more bile duct exploration (37.6% vs 5.7%, p0.001). Although not statistically significant, sub-total cholecystectomy rate was lower if operation carried out by biliary surgeon (3.2% vs 6.8%, p=0.132). The rate of readmission within 30 day was also lower if operation carried out by biliary surgeon (2.4% vs 7.3%, p=0.046). Conclusion Subspecialization significantly enhances outcomes in benign biliary surgery. Greater emphasis should be placed on optimizing training pathways and recruitment processes. Additionally, annual audits of outcomes against established benchmarks should be mandated to ensure continuous improvement.