TPT 8.11 One-Stop ERCP-to-Laparoscopic Cholecystectomy for Choledocholithiasis: A District General Hospital Quality Improvement Pathway Delivering Better Flow, Better Experience, and Lower Cost

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ID: 324017
2026
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Abstract
Abstract Aims Choledocholithiasis admissions experience fragmented inpatient care, prolonged length of stay, delayed cholecystectomy, and emergency readmissions. We introduced a “one-stop” pathway providing ERCP followed by laparoscopic cholecystectomy on the same day or within 24 hours via the emergency (CEPOD) list. We evaluated feasibility, patient experience, and cost impact. Methods A service evaluation was conducted over 6 months in a district general hospital. Patients underwent ERCP followed by laparoscopic cholecystectomy on the following day. Outcomes included pathway deliverability within existing emergency theatre scheduling and patient feedback. Cost modelling used local fully absorbed reference costs: bed day £367/day, MRCP £177, elective laparoscopic cholecystectomy £5,969, emergency laparoscopic cholecystectomy £8,976. Emergency readmission £1000 and ERCP were estimated at £1,000–£2,000 per procedure. Results Twenty patients completed the one-stop ERCP-to-cholecystectomy pathway. The pathway was deliverable within existing emergency theatre capacity without additional elective resources and was well received by patients, who valued definitive treatment in a single admission and reduced uncertainty regarding waiting timing. Cost modelling demonstrated gross savings of £2,367–£4,367 per patient, driven by avoiding extra bed days and reducing preventable interval events (readmission, repeat ERCP and MRCP). Emergency cholecystectomy incurs additional cost compared with elective surgery (£8,976 vs £5,969). After accounting for this, the pathway remained cost-saving at £1,360 per patient (£27,200 across 20 patients) at the minimum. Conclusions A one-stop ERCP-to-laparoscopic cholecystectomy pathway is feasible and patient-centred in a district general hospital. Despite CEPOD cholecystectomy, it is cost-saving by reducing bed days, readmissions and repeat procedures, with patient satisfaction.
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Authors Franklin Chikodi Udo Kalu, Kira Ford Busson, Sithdharthan Ravikumar, Shashikanth Vijayaraghavalu, Olufemi Oduneye, Pranav Hebbalu, MuhammadImran Aslam, Christian Katz
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag087.268
URL
https://doi.org/10.1093/bjs/znag087.268
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