TPTh 3.05 Gallstone Disease – Is it Suitable for Ambulatory Care?

Abstract Aims Gallstone related disease is a frequent cause of attendance to the emergency department (ED), and subsequent admission to general surgery. The aim of this study is to review all patients who attended ED in a large district general hospital and correlate factors that may indicate the need for surgical admission versus an ambulatory approach. Methods In this retrospective cohort study, all patients coded as biliary disease who attend the ED over a two-month period were reviewed. Data collection included patient demographics, length of hospital stay (LOS), white cell count (WCC), c reactive protein (CRP), liver function tests (LFT), basic vitals including temperature, and imaging. Results 101 patients were included. The ambulatory group (n=38) had a mean age of 43 years (17-79), with a mean WCC of 9.1x109/L (3.6 - 16.6), CRP of 14.9mg/L (0.3 – 107) and a mean temperature of 36.6 degrees Celsius (35.8-38.1). In comparison the surgical admission group (n=63) had a mean age of 59 years (18-90), with a mean WCC of 13.1 x109/L (4.1 – 27), CRP of 80mg/L (0.8 – 318) and a mean temperature of 36.9 degrees Celsius (35.1 – 39.5). Four patients (10.5%) within the ambulatory group were subsequently admitted demonstrating a failure to ambulate; while 5 (7.9%) patients in the admission group had a length of stay of 1 day. Conclusions A significant number of patients (37.6%) of biliary patients can be ambulated reducing the need for inpatient beds; however, WCC, CRP and temperature cannot be used in isolation. Clinical assessment remains paramount.