980 Audit of the Day Case Laparoscopic Cholecystectomy Pathway in Frimley Park Hospital

Abstract Aim To confirm the proportion of patients that stayed overnight in the hospital after their cholecystectomy. To determine the major causes of patients staying overnight in the hospital. To ensure Laparoscopic Cholecystectomy is being performed according to Get It Right First time (GIRFT) guideline GIRFT recommendation Anticipated day case rate of 90%. Standard positioning of patient, with slight head up, table rotation towards surgeon. Use intermittent pneumatic compression for DVT prophylaxis. Local anaesthetic to all port sites before insertion of ports (10mls 0.5% bupivacaine*). Use of three 5mm ports and one 10mm port. Low pressure CO2 insufflation (10mmHg). Meticulous washout at end of procedure. Instillation of 30mls 0.25% bupivacaine* around liver and gallbladder. No drains Method All cases of Elective Cholecystectomy done within July 1st, 2023, to October 31st 2023 at Frimley Park Hospital was included in the study. Electronic case notes and Operative notes was used to get required data. A total of 107 Laparoscopic Cholecystectomy was recruited Results Day case Rate was 45% (58 of 107 stayed overnight), Although 85% eventually went home the morning after the Surgery. Interestingly , 34% of those that stayed overnight had no Clinical indication to stay and was mostly Patient personal preference and delay in Recovery time. No surgeon documented the Pneumoperitoneum pressure used Conclusions Use of GIRFT recommended surgical technique. Proper documentation of the reason patient stayed overnight. All patients should be counselled Preoperatively to have someone to pick them once medically fit to go home even if recovery gets delayed to 20.00hrs.