Enhancing Timing and Referral Pathways for Laparoscopic Cholecystectomy: A Two-Cycle Audit.

BACKGROUND: Laparoscopic cholecystectomy is the definitive treatment for symptomatic gallstone disease. National guidelines recommend surgery within two to six weeks following presentation to reduce complications and unplanned readmissions. This audit aimed to evaluate adherence to local guidance on timing and referral for laparoscopic cholecystectomy and assess the impact of service improvements. METHODS: A two-cycle audit was conducted. The first cycle (July-August 2024, n=70) assessed the referral process, pre-assessment clinic (PAC) attendance, and booking timelines. Interventions included a structured cholecystectomy pathway, teaching sessions, and a standardised booking email. The second cycle (July-August 2025, n=50) reviewed outcomes following implementation. Key measures were PAC attendance, surgical booking timeliness, avoidance of unnecessary follow-up, and readmission rates. RESULTS: In the first cycle, only 3% had PAC arranged, with a 36% readmission rate. In the second cycle, PAC improved to 16%, follow-ups were avoided in 30%, and readmissions were reduced to 22%. However, booking delays persisted, with 36% scheduled at three months and 40% not booked at all. CONCLUSION: Service interventions improved PAC attendance and reduced readmissions; however, delays in surgical booking remain the principal obstacle to achieving timely laparoscopic cholecystectomy. Further integration of the pathway into routine practice, along with addressing theatre capacity constraints, is essential to meet guideline standards and optimise patient outcomes.