SP2.15 Evaluating the Outcomes of Out-of-Hours Cholecystectomy: A Systematic Review

Aims NICE Guidance (CG188) recommends offering early laparoscopic cholecystectomy within 1 week of diagnosis for patients presenting with acute cholecystitis. Facilitating this in a modern NHS system however presents huge challenges. Increasing demand and limited estate capacity means acute in-patient cholecystectomy is often delayed or prioritised less than other emergency cases. It remains rare that Laparoscopic Cholecystectomy is undertaken out of hours. This systematic review aims to evaluate the safety and applicability of undertaking cholecystectomy out of hours (OOH) by assessing complication rates in-hours (IH) and OOH. Methods A systematic review was conducted using PubMed, Medline, and EMBASE databases, according to PRISMA guidelines. All primary research studies involving patients over 16 undergoing cholecystectomy using any approach were included. Outcomes included complication and conversion rates. Included papers were assessed for bias using ROBINS-I. Results From 1521 screened abstracts, 17 papers were included, reporting 189,579 cholecystectomies. 15 studies were retrospective and 2 prospective. Due to heterogeneity of data, meta-analysis was not performed. 14 papers report no significant difference in complication rates between IH and OOH cholecystectomy. Separately, two papers reported an increased rate of conversion to open out of hours. The overall risk of bias was rated as low or moderate across the included studies. Conclusion This study suggests that OOH cholecystectomy is safe with those included studies indicating that complication rates for OOH cholecystectomy are comparable to IH. As such optimising theatre activity by utilising OOH availability could provide improved timeliness to surgery, improve patient outcomes and benefit hospital flow.