GIRFT has produced new guidance supporting NHS teams to carry out earlier laparoscopic cholecystectomy in patients with gallstone disease, helping to reduce the number of days spent in hospital and supporting waiting list recovery.
Data shows that most patients in England have laparoscopic cholecystectomy (minimally invasive surgery to remove the gallbladder) six weeks or more after they present as an emergency.
However, a significant body of evidence shows that delayed surgery leads to 20-30% readmission rates and a more complex operation, while early laparoscopic cholecystectomy (within seven days of presentation) is safe and results in fewer bed days for patients.
GIRFT’s new guidance details how organisations can increase the number of emergency patients undergoing early laparoscopic cholecystectomy, also known as hot gallbladder surgery.
The guide offers practical advice to help services optimise care for patients with gallstone disease at all stages of the pathway, and includes best practice for:
- Emergency assessment for gallstone disease
- What a successful hot gallbladder pathway looks like
- Switching to a hot gallbladder pathway
- Managing demand and capacity
- Using data to govern the pathway
- Anaesthetics and pre-assessment
- Booking and digital support
The guide also includes action checklists and case studies from teams who have successfully established a hot gallbladder pathway.
Mark Cheetham, GIRFT clinical lead for general surgery, said:
"We have seen huge unwarranted variation in the rates of index admission hot cholecystectomy, despite strong evidence that widespread adoption of early emergency cholecystectomy across England would have significant benefits.
We hope this guidance supports providers to establish a hot gallbladder pathway for early laparoscopic cholecystectomy, resulting in less time off work and fewer days in hospital for patients, as well as a reduction in the number of patients added to the elective waiting list and a reduced risk of infections."
