Quality standard
Quality statement 1: Acute cholecystitis
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
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
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 NHS Digital's Hospital Episode Statistics.
b) Length of stay for adults with acute cholecystitis.
Data source: Local data collection. National data can be collected from NHS Digital's Hospital Episode Statistics.
c) Quality of life for adults with acute cholecystitis.
Data source: Local data collection.
What the quality statement means for different audiences
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 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.
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. NICE guideline CG188 (2014), 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 NICE's guideline on gallstone disease]