AB070. SOH24AB_097. A long way from Tokyo?—Management of patients with acute cholecystitis in Ireland: a national registry-based study

Background: Acute cholecystitis is a common general surgical emergency, accounting for up to 10% of all patients attending with acute abdominal pain. International guidelines suggest that emergency cholecystectomy is the treatment of choice for uncomplicated acute cholecystitis where feasible. Methods: All patients with acute cholecystitis presenting to public hospitals in Ireland between January 2017 and July 2023 were identified using the National Quality Assurance and Improvement System (NQAIS). Data were collected on patient demographics, co-morbidities, length of stay (LOS), operative intervention, endoscopic intervention, critical care admissions, in-patient mortality, and readmissions. Results: A total of 20,886 admission episodes were identified involving 17,958 patients. Among them, 3,585 (20%) patients underwent emergency cholecystectomy in total; 3,436 (96%) of these were performed laparoscopically, with 140 (4%) requiring conversion to an open procedure, and common bile duct injuries occurring in 4 (0.1%) of patients. In comparison to patients treated conservatively, patients who underwent cholecystectomy were younger (median 50 vs. 60 years, P<0.001) and more likely to be female (64% vs. 55% P<0.001). Following propensity score matched analysis, those who had an emergency cholecystectomy had reduced LOS [median 5 days, interquartile range (IQR): 3–8 days vs. 6 days, IQR: 3–10 days, P<0.001] and fewer readmissions to hospital {282 (8%) vs. 492 (14%), age >65 years [odds ratio (OR): 1.526], Charlson comorbidity index (CCI) >3 (OR: 2.281) and non-operative management (OR: 1.136)} were significant risk factors for adverse outcome. Conclusions: Uptake of emergency cholecystectomy in Ireland remains low, and is carried out on a younger, fitter cohort of patients. In those patients, however, it is associated with improved outcomes for cholecystitis compared to conservative management.