STREAMLINING ERCP AND CHOLECYSTECTOMY: INCREASING VOLUMES OF ERCP + CHOLECYSTECTOMY DONE ON THE SAME DAY TO DECREASE LENGTH OF STAY

ABSTRACT

DDW 2022 Author Disclosures Maaz Sohail NO financial relationship with a commercial interest ;Andrew Mims NO financial relationship with a commercial interest ;James Pitcher NO financial relationship with a commercial interest ;William Oelsner NO financial relationship with a commercial interest ;George Philips NO financial relationship with a commercial interest Background: Biliary stone disease is a common cause of inpatient hospitalization, and many cases require an endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC). As these procedures are done by different departments, coordination can be challenging and both interventions are therefore not usually done on the same day. In the COVID-19 pandemic era, we have seen a greater need to decrease length of stay for patients in the hospital thereby reducing overall costs to both hospitals and patients, increasing bed availability as well as decreasing the exposure of easily transmissible diseases such as COVID-19. Aim: To show that same day ERCP and laparoscopic cholecystectomy can be performed at similar volumes to different day procedures in a teaching hospital and that this would allow for a shorter length of stay for these patients. Methods: A retrospective cohort study was done to identify all patients carrying the diagnosis of gallstone pancreatitis, cholangitis, choledocholithiasis, or a positive intraoperative cholangiogram who also underwent an ERCP and cholecystectomy during that same admission from November 2017 to October 2021 at our hospital. A total of 385 patients were found. These patients were divided into those that underwent an ERCP and cholecystectomy on the same day (n = 158) and those that had each procedure on a different day (n = 227). An ad hoc analysis of 170 patients (same day n = 77, different day n = 93) was done for further chart analysis to find total hospital length of stay, age, Body Mass Index (BMI), and comorbidities. Results: Same-day ERCP and LC comprised a significant volume (41.1 %) of the total procedures done for these diagnoses. In the subset data, hospital length of stay of patients who received ERCP and LC procedure on the same day is significantly shorter than that of patients who received these procedures on different days (median (IQR)= 4(3, 5) vs 5(4, 6), p=0.0001). Both groups had similar mean age and BMI. Post operative complications were found in 5.2% of the same day group and 3.2 % of the different day group. Similarly, post ERCP complications were found in 3.8% of patients in the same day group and 4.3 % of patients in the different day group. Conclusion: We show that in our teaching hospital, a significant number of patients regardless of age or BMI can undergo both ERCP and cholecystectomy in the same day and decrease their length of stay. This will also lead to decreased costs for patients and the hospital. Effective and early communication between the Gastroenterology, Anesthesia, and Surgery departments of a hospital may be a key in achieving these results. [Formula presented]