Quality statement 1: Acute cholecystitis

Quality statement

Adults with acute cholecystitis have laparoscopic cholecystectomy within 1 week of diagnosis.

Rationale

The earlier a laparoscopic cholecystectomy is performed, the less potential there is for recurrent events such as inflammation and the infection spreading during the wait for surgery. If laparoscopic cholecystectomy cannot be performed within 1 week of diagnosis of acute cholecystitis, surgery should be delayed until the acute episode has subsided (more than 4 weeks after diagnosis).

Quality measures

Structure

a) Evidence of local arrangements to ensure that adults with acute cholecystitis have laparoscopic cholecystectomy within 1 week of diagnosis.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that secondary care services that offer laparoscopic cholecystectomy regularly perform the procedure.

Data source: Local data collection.

Process

Proportion of adults with acute cholecystitis who have a laparoscopic cholecystectomy within 1 week of diagnosis.

Numerator – the number in the denominator who have a laparoscopic cholecystectomy within 1 week of diagnosis.

Denominator – the number of adults with acute cholecystitis.

Data source: Local data collection.

Outcome

a) Acute readmission rates for adults with acute cholecystitis.

Data source: Local data collection. National data can be collected from the Health and Social Care Information Centre's Hospital Episode Statistics.

b) Length of stay for adults with acute cholecystitis.

Data source: Local data collection. National data can be collected from the Health and Social Care Information Centre's Hospital Episode Statistics.

c) Quality of life for adults with acute cholecystitis.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as secondary care services) ensure that surgeons are trained to perform laparoscopic cholecystectomy, and that adults with acute cholecystitis can have the procedure within 1 week of diagnosis.

Healthcare professionals (such as upper gastrointestinal surgeons) are trained to perform laparoscopic cholecystectomy, and provide it to adults with acute cholecystitis within 1 week of diagnosis.

Commissioners (such as clinical commissioning groups) monitor services that offer laparoscopic cholecystectomy to ensure that they regularly perform it, and that adults with acute cholecystitis can have the procedure within 1 week of diagnosis.

What the quality statement means for patients and carers

Adults with acute cholecystitis (infection in the gallbladder) have keyhole surgery to remove their gallbladder (part of the digestive system) within 1 week of the infection being diagnosed, to reduce the risk of pain, swelling, and the infection spreading while waiting to have surgery.

Source guidance

  • Gallstone disease (2014) NICE guideline CG188, recommendation 1.2.4 (key priority for implementation).

Definitions of terms used in this quality statement

Diagnosing acute cholecystitis

Acute cholecystitis is diagnosed using abdominal ultrasound to confirm the presence of gallstones and signs of acute gallbladder pathology. [Expert opinion]

Laparoscopic cholecystectomy

Removal of the gallbladder through 'keyhole' surgery. It should be performed within 1 week of diagnosis of acute cholecystitis. If it cannot be performed within 1 week of diagnosis, surgery should be delayed until the acute episode has subsided (more than 4 weeks after diagnosis).

[Adapted from gallstone disease (NICE guideline CG188)]