621 Sustainable Training-Friendly Service Provision to Reduce the Burden of Gallstone Disease: A Tertiary Care Surgical Unit Experience

Abstract Aim NICE guidelines recommend laparoscopic cholecystectomy for symptomatic gallstones during the index admission. COVID-19 restrictions highlighted the need for a dedicated emergency theatre for acute biliary diseases, leading to the introduction of the 'Hot Gallbladder' service. This study assesses the service's impact on reducing recurrent admissions and expediting cholecystectomies in a University Hospital. Method A prospective study was conducted between March to August 2023 in a tertiary care surgical unit on patients referred to the Hot Gallbladder service. This service was a weekly Friday morning theatre list managed by registrars under consultant supervision. Data extracted included patient demographics, diagnosis, previous hospital admissions, cancellations, and admission duration. Results Between March to August 2023, 152 gallstone-related admissions were recorded. Thirty-two cases were expedited to the Hot gallbladder service, consisting of 7 males and 25 females with a median age of 45 (32.5, 64.5) years. Twenty-six underwent cholecystectomy; two withdrew consent, and four were cancelled on the day due to theatre overrun. Two patients (8%) had same-admission cholecystectomies, while 24 (92%) were operated within 2 weeks, with a median of 2 (1, 2.75) previous hospital admissions. Conclusions The Hot Gallbladder service offered prompt definitive treatment to 21% of patients while providing valuable training for registrars. In the context of biliary presentations, failure to perform cholecystectomies on peri-index presentation not only incurs substantial financial costs but also predicts future readmissions, adding to the overall strain on scarcely resourced NHS services and significantly impacting patients’ quality of life. Data from this study will contribute to a cost effectiveness analysis.