Improvement of the Laparoscopic Cholecystectomy Service at a District General Hospital during the COVID-19 Pandemic

Background: British Association of Day Surgery and Royal College of Anaesthetists guidelines specify that 75% of elective Surgery should be done as a day-case. Our Trust reported a laparoscopic cholecystectomy day-case rate of 25% pre-pandemic. Following The first wave of The pandemic our waiting list increased significantly. Therefore, to address this, we aimed to improve The day-case rate by developing The booking pathway, such as introducing The Cholecystectomy As A Day-case (CAAD) score. Method(s): Retrospective data for laparoscopic cholecystectomy were reviewed between 19th March and 9th July 2021. Specific documents reviewed were The operation booking forms, hospital-specific 'boarding cards' for booking and CAAD score completion, and a day-case rate was calculated. Result(s): A total of 86 procedures were performed. There was an overall day-case rate of 54.7%. of those booked to be day-cases (n=39), 61.5% remained day-case post-operatively and 28.2% were discharged The next day. of The patients that were not discharged The same day (n=39), 18 cases had no documented reason for The additional stay. Incomplete booking forms (n=42) demonstrated a day-case rate of 50% versus 60.5% with complete forms (n=38). Conclusion(s): Overall, The day-case rate has improved. We believe this is from adhering to The boarding card and introduction of The CAAD score to guide appropriate booking. However, for further improvement we are going to revise The booking form and create a Standard Operating Procedure (Sop) for The booking of these operations. Together with CAAD scoring, this should improve day-case rates further to reach The nationally accepted standard.

COVID-19 should be considered as a differential diagnosis for an 'acute abdomen'

SARS-CoV2 is a novel RNA virus which originated in Wuhan, China early in January 2020 and spread as a global pandemic. The virus, thought to cause primarily respiratory pathology, is presenting with more extra-pulmonary presentations as time progresses. Abdominal symptoms, such as acute abdominal pain, can present without any respiratory complaints which can cause a diagnostic dilemma for the treating physician, leading to delayed or missed diagnoses and often resulting in a suboptimal outcome for the patient.