Emergency Laparoscopic Cholecystectomy Pathway Reduces Elective Waiting Times and Preoperative Admissions: A Prospective Propensity-Matched Cohort Study

TL;DR

A new pathway for emergency gallbladder surgery reduces waiting times for elective procedures and improves hospital efficiency.

Contribution

Demonstrates that an emergency laparoscopic cholecystectomy pathway reduces elective waiting times and preoperative admissions.

Findings

Emergency cases had longer operative times and higher rates of subtotal cholecystectomy and postoperative ERCP.

Implementing the ELC pathway reduced elective waiting times from nine to three months.

The pathway managed 69.2% of emergency cases as day cases and discharged 84.4% the following day.

Abstract

Background: Emergency laparoscopic cholecystectomy (ELC) has emerged as a viable alternative to delayed elective surgery for acute gallstone disease, although its widespread adoption is hindered by cultural barriers. This study compares outcomes between elective and emergency laparoscopic cholecystectomy and evaluates the impact of implementing an ELC pathway on elective waiting times, patient outcomes, and overall service delivery. Methods: A prospective cohort study was conducted between December 2021 and December 2023, including all patients undergoing emergency or elective laparoscopic cholecystectomy. One-to-one propensity score matching, correlation statistics, and multivariate logistic regression were used to analyse outcomes. Results: Of 585 patients, 314 (53.4%) underwent emergency and 271 (46.3%) elective cholecystectomies. After matching, 474 patients were analysed (237 per group). The ELC pathway achieved an 81.4% first-presentation procedure rate, with 69.2% managed as day cases and 84.4% discharged the following day. Emergency cases had longer operative times (+9 min), higher rates of subtotal cholecystectomy (8.9% vs. 3.0%, p < 0.001), and more frequent postoperative ERCP (16.9% vs. 4.6%, p < 0.001). Other outcomes were comparable. Introduction of the ELC pathway significantly reduced elective waiting times from a median of nine to three months (R = −0.219, R2 = 0.059, p < 0.001) and preoperative admissions (IQR 0–1, R = −0.223, R2 = 0.050, p = 0.002). Conclusions: An ELC pathway is a safe and effective alternative to elective gallstone surgery, offering substantial benefits to patients and healthcare systems, while serving as a strategic, cost-conscious approach to reducing surgical waiting times and preoperative admissions. Its success hinges upon surgical expertise in acute decision making, skill in performing subtotal cholecystectomy, and access to institutional resources such as advanced imaging and ERCP services.

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