30-day readmission rate following laparoscopic cholecystectomy in North Devon District Hospital over a three-year period – a closed loop audit

Abstract

Introduction

Laparoscopic cholecystectomy is the most performed hepatobiliary procedure in the United Kingdom and worldwide. Readmission rate following surgery is considered a key performance indicator and care quality measure. Reducing this will allow for effective cost savings in the National Health Service. The aim was to determine 30-day readmission rate post-laparoscopic cholecystectomy, identify the indications for readmission and reduce this rate.

Methods

From a database of consecutive patients undergoing cholecystectomy over a 3-year period between 2019-2021, data on demography, comorbidity, and 30-day readmission rates over three separate time periods were extracted and evaluated. Findings were presented at the local departmental governance meeting after each audit round. Recommendations including introducing a standardised post-operative analgesia protocol were made and implemented prior to re-audit.

Results

A total of 883 patients had laparoscopic cholecystectomy: 69% females and 31% males. 70% were performed as day case. Overall readmission rate was 6% (5%; day case and 6%; overnight-cases). Readmission rates were 4%, 6% and 6% for years 2019, 2020 and 2021 respectively. Indications for readmission were biliary in 22% and non-biliary in 78%. Common indications for readmission were abdominal pain, postoperative infection, retained stone and pancreatitis. Non-specific abdominal pain was the commonest indication. Following adjustment for comorbidity; increasing age and male gender were associated with an increased rate for admission.

Conclusion

Readmission rates following laparoscopic cholecystectomy in North Devon District Hospital over a three-year period were less than 10% in accordance with Association of Upper Gastrointestinal Surgeons standards. Standards have been maintained following a re-audit.