SP4.10 Establishing an Emergency Laparoscopic Cholecystectomy Pathway Reduces Elective Waiting Times

Aim Emergency laparoscopic cholecystectomy (ELC) practice in the United Kingdom still faces cultural barriers despite mounting evidence for its benefits. The RCS of England Cholecystectomy Quality Improvement Collaborative (Chole-QulC) supported our centre develop an ELC pathway. This study compares outcomes of elective versus ELC, and explores the impact of the ELC pathway on services Methods A prospective observational study examining emergency and elective laparoscopic cholecystectomy between December 2021 and December 2023.One-to-one propensity score matching, correlation statistics and multivariate logistical regression models were used to analyse outcomes. Results The study followed 314/585 (53.4%) emergency and 271/585 (46.3%) elective cholecystectomy patients. Matched data examined 237 patients per group. The ELC pathway achieved 81.4% first-presentation procedures, with 69.2% day-case and 84.4% next-day discharge rate. The ELC cohort experienced a nine-minutes longer operation, higher subtotal cholecystectomy (8.9% vs. 3.0%, p<0.001) and postoperative ERCP rates (16.9% vs. 4.6%, p<0.001). Subtotal cholecystectomy and postoperative ERCP were significantly associated with prolonged waiting time to surgery >1 year (OR 2.24, p=0.028 and OR 3.83, p=0.030 respectively). The introduction of an ELC pathway significantly reduces elective waiting time form a median of nine to three months over a two-year period (R=-0.219, R²=0.059, p<0.001) Conclusion An ELC pathway is safe, with additional positive implications for patient outcomes and service costs, by reducing waiting time and preoperative admissions. ELC offers a high first-presentation procedure and day-case rate.