title: Are we meeting the British Society of Gastroenterology guidelines for cholecystectomy post-gallstone pancreatitis?
abstract: BACKGROUND
  The aim of this study was to audit the current management of patients suffering with gallstone pancreatitis (GSP) at a university teaching hospital for compliance with the British Society of Gastroenterology (BSG) guidelines regarding cholecystectomy post-GSP.
  
  
  METHODS
  Data were collected on all patients identified via the hospital coding department that presented with GSP between January 2011 and November 2013. Patients with alcoholic pancreatitis were excluded. The primary outcome was the length of time in days from diagnosis of GSP to cholecystectomy. Secondary outcomes included readmission with gallstone-related disease prior to definitive management and admitting speciality.
  
  
  RESULTS
  One hundred and fifty-eight patients were identified with a presentation of GSP during the study period. Thirty-nine patients were treated conservatively. One hundred and six patients underwent laparoscopic cholecystectomy a median (interquartile range) interval of 33.5 days (64 days) post-admission. Patients with a severe attack as classified by the Glasgow severity score (n = 16) waited a median of 79.5 days (71.5) for cholecystectomy. Only 32% (n = 34) of patients with mild disease underwent cholecystectomy during the index admission or within 2 weeks. When grouped by admitting speciality, patients admitted initially under hepatobiliary surgery waited significantly fewer days for definitive treatment compared with other specialities (P < 0.0001). Twenty-one patients (19.8%) re-presented with gallstone-related pathology prior to undergoing cholecystectomy.
  
  
  CONCLUSIONS
  Only 32.1% were treated as per BSG guidelines. About 19.8% (n = 21) of the patients suffered further morbidity as a result of a delayed operation and there is a clear difference between admitting speciality and the median time to operation.
authors.affiliation: Department of Hepatobiliary Surgery, Royal Derby Hospital, Derby, UK.
authors.forename: Lee R
authors.initials: LR
authors.lastname: Creedon
authors.affiliation: Department of Hepatobiliary Surgery, Royal Derby Hospital, Derby, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Neophytou
authors.affiliation: Department of Upper Gastrointestinal Surgery, Royal Derby Hospital, Derby, UK.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Leeder
authors.affiliation: Department of Hepatobiliary Surgery, Royal Derby Hospital, Derby, UK.
authors.forename: Altaf K
authors.initials: AK
authors.lastname: Awan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000150:complications / Q000601:surgery*; D005762:Gastroenterology / Q000592:standards*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012955:Societies, Medical; D013997:Time Factors; D006113:United Kingdom; D055815:Young Adult
keywords: cholecystectomy; gallstones; general surgery; laparoscopic; morbidity; pancreatitis