TTP8.06 Analysis of existing cholecystostomy management to create a standardised care pathway in the Emergency General Surgery unit of a Tertiary Centre: a Quality Improvement Project

Aims to analyse current management of cholecystostomies post-procedure, and to create a clear, standardised care pathway for patients who have cholecystostomies inserted following presentation with acute biliary pathology. Methods Clinical data for all cholecystostomy insertions between January 2021 and October 2024 were retrospectively analysed. Data collection focus included cholecystostomy indication, patient demographics and performance status, patency imaging, removal timeframes, and use of ambulatory clinic. Results Of 184 records analysed, the primary indication for cholecystostomy was acute cholecystitis with or without perforation, in patients deemed permanently too high-risk for laparoscopic cholecystectomy [99]. Other aetiologies included cholecystitis-induced biliary sepsis refractory to medical sepsis management, and biliary malignancy [53, 11]. Significant heterogeneity was demonstrated regarding post-procedure management, particularly surrounding drain status at discharge (drain spigotted/left on free drainage), cholecystostomy patency imaging before or after discharge [56 inpatient, 66 outpatient], and cholecystostomy length of time in situ [range <1 week-26 weeks]. 108 patients were followed up via ambulatory clinic, and number of visits also demonstrated wide variation [range 1-9 visits]. 51 patients re-presented with acute biliary pathology following removal of cholecystostomy, and 26 patients were subsequently managed surgically with cholecystectomy. 22 patients died during original admission. Conclusion While cholecystostomy was demonstrated as a mainstay of management in high risk patients with acute biliary pathology, significant variability was demonstrated regarding post-procedure management. This contributed to multiple patient returns to hospital, and significant ambulatory clinic resource use. Our care pathway offers guidance for discharge and removal timeframes, to ameliorate foreseeable complications for patients in community.