Index cholecystectomy in a rural hospital: it can be done

Background Index cholecystectomy ( IC ) refers to an operation during a patient's first hospital admission with symptomatic gallstone ( GS ) disease. There are proven reductions in cost, hospital bed days and GS ‐related complications while awaiting elective surgery. IC has not been universally adopted, particularly in smaller centres where logistics can present a barrier. The aim of this paper is to describe the introduction of routine IC at Hastings Hospital and the effects in terms of waiting time until surgery; GS ‐related re‐presentations and complications while awaiting surgery; operative complications and overall hospital stay. Methods Data were collected for all patients who underwent cholecystectomy in the year following the introduction of IC (2015/2016). The results were compared with data from the year 2009/2010. Results A total of 259 cholecystectomies were performed over the 2015/2016 study period compared with 186 in the 2009/2010 study period. The IC rate increased from 9.89% in 2009 to 75.4% in 2015 ( P < 0.001). The incidence of GS pancreatitis whilst waiting for surgery reduced from six in 2009 compared with one in 2015 ( P = 0.046). The operative complications were similar in both groups. Total hospital stay was also similar. Conclusion The study shows that it is possible to perform IC in a rural setting reducing complications of waiting and in particular, rates of GS ‐related pancreatitis were significantly reduced. It can be done safely with an accommodating acute on‐call system.