Index cholecystectomy: a continuing challenge for a provincial hospital.

Aims: To review the management of acute gallstone disease at a provincial New Zealand centre and compare to current national/international practice.

Methods: All patients presenting to Nelson Hospital with acute gallstone-related pathology were identified from the study period. The first presentation within the audit period was defined as the index admission. Length of stay and interventions were recorded. Waiting lists were compared.

Results: Between January 2004 to December 2010, 390 patients were admitted with acute gallstone-related pathology to Nelson Hospital. The index cholecystectomy rate was 17% (57/329) after exclusion of 61 ineligible patients; 158/329 patients subsequently underwent elective cholecystectomy, with patients waiting a median time of 97 days (range 7-1922). There were 132 Emergency Department visits (median one (range 0-8)), and 59 readmissions with acute gallstone-related pathology for those waiting for cholecystectomy. Of the 37 admitted with gallstone pancreatitis, 11 underwent cholecystectomy within 2 weeks of index admission. Waiting lists remained unchanged over time.

Conclusions: Nelson Hospital has a low rate of index cholecystectomy. High numbers of patients represent to the emergency department or are readmitted whilst waiting for definitive surgery. Patients presenting with gallstone pancreatitis fail to receive treatment in accordance with international management guidelines.