{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:38:37Z","timestamp":1791999517297,"version":"4.4.0"},"reference-count":37,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T00:00:00Z","timestamp":1750982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Emergency laparoscopic cholecystectomy (ELC) has emerged as a viable alternative to delayed elective surgery for acute gallstone disease, although its widespread adoption is hindered by cultural barriers. This study compares outcomes between elective and emergency laparoscopic cholecystectomy and evaluates the impact of implementing an ELC pathway on elective waiting times, patient outcomes, and overall service delivery. Methods: A prospective cohort study was conducted between December 2021 and December 2023, including all patients undergoing emergency or elective laparoscopic cholecystectomy. One-to-one propensity score matching, correlation statistics, and multivariate logistic regression were used to analyse outcomes. Results: Of 585 patients, 314 (53.4%) underwent emergency and 271 (46.3%) elective cholecystectomies. After matching, 474 patients were analysed (237 per group). The ELC pathway achieved an 81.4% first-presentation procedure rate, with 69.2% managed as day cases and 84.4% discharged the following day. Emergency cases had longer operative times (+9 min), higher rates of subtotal cholecystectomy (8.9% vs. 3.0%, p &lt; 0.001), and more frequent postoperative ERCP (16.9% vs. 4.6%, p &lt; 0.001). Other outcomes were comparable. Introduction of the ELC pathway significantly reduced elective waiting times from a median of nine to three months (R = \u22120.219, R2 = 0.059, p &lt; 0.001) and preoperative admissions (IQR 0\u20131, R = \u22120.223, R2 = 0.050, p = 0.002). Conclusions: An ELC pathway is a safe and effective alternative to elective gallstone surgery, offering substantial benefits to patients and healthcare systems, while serving as a strategic, cost-conscious approach to reducing surgical waiting times and preoperative admissions. Its success hinges upon surgical expertise in acute decision making, skill in performing subtotal cholecystectomy, and access to institutional resources such as advanced imaging and ERCP services.<\/jats:p>","DOI":"10.3390\/medsci13030086","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T06:46:12Z","timestamp":1751438772000},"page":"86","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Emergency Laparoscopic Cholecystectomy Pathway Reduces Elective Waiting Times and Preoperative Admissions: A Prospective Propensity-Matched Cohort Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7159-2435","authenticated-orcid":false,"given":"Mohammed","family":"Hamid","sequence":"first","affiliation":[{"name":"General Surgery Department, Russell\u2019s Hall Hospital, Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley DY1 2HQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5273-3386","authenticated-orcid":false,"given":"Omar E. S.","family":"Mostafa","sequence":"additional","affiliation":[{"name":"General Surgery Department, Russell\u2019s Hall Hospital, Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley DY1 2HQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Kausar","sequence":"additional","affiliation":[{"name":"General Surgery Department, Russell\u2019s Hall Hospital, Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley DY1 2HQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amina","family":"Amin","sequence":"additional","affiliation":[{"name":"General Surgery Department, Russell\u2019s Hall Hospital, Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley DY1 2HQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oladapo","family":"Olajumoke","sequence":"additional","affiliation":[{"name":"General Surgery Department, Russell\u2019s Hall Hospital, Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley DY1 2HQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhinav","family":"Singhal","sequence":"additional","affiliation":[{"name":"General Surgery Department, Russell\u2019s Hall Hospital, Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley DY1 2HQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gowtham","family":"Bharnala","sequence":"additional","affiliation":[{"name":"General Surgery Department, Russell\u2019s Hall Hospital, Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley DY1 2HQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0325-8440","authenticated-orcid":false,"given":"Akinfemi","family":"Akingboye","sequence":"additional","affiliation":[{"name":"General Surgery Department, Russell\u2019s Hall Hospital, Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley DY1 2HQ, UK"},{"name":"Aston Medical School, College of Health and Life Science, Aston University, Birmingham B4 7ET, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Camprodon","sequence":"additional","affiliation":[{"name":"General Surgery Department, Russell\u2019s Hall Hospital, Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley DY1 2HQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaminda","family":"Sellahewa","sequence":"additional","affiliation":[{"name":"General Surgery Department, Russell\u2019s Hall Hospital, Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley DY1 2HQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"key":"ref_1","unstructured":"NHS England (2025, April 28). Referral to Treatment (RTT) Waiting Times Data. Available online: https:\/\/www.england.nhs.uk\/statistics\/statistical-work-areas\/rtt-waiting-times\/."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"COVIDSurg Collaborative (2020). Elective surgery cancellations due to the COVID-19 pandemic: Global predictive modelling to inform surgical recovery plans. Br. J. Surg., 107, 1440\u20131449.","DOI":"10.1002\/bjs.11746"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"COVIDSurg Collaborative (2020). Global burden of surgical backlog following the COVID-19 pandemic: Modelling study. Lancet, 396, 27\u201338.","DOI":"10.1016\/S0140-6736(20)32275-3"},{"key":"ref_4","unstructured":"OECD (2020). Waiting Times for Health Services: Next in Line, OECD Publishing. OECD Health Policy Studies."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"AlSaleh, N., Alaa adeen, A.M., Hetta, O.E., Alsiraihi, A.A., Bader, M.W.M., Aloufi, A.K., ALZahrani, F.M., Ramadan, M., Ageel, A.H., and Alzahrani, M. (2024). Emergency cholecystectomy: Risk factors and impact of delay on electively booked patients, a 5-year experience of a tertiary care center. BMC Surg., 24.","DOI":"10.1186\/s12893-024-02694-8"},{"key":"ref_6","first-page":"20","article-title":"Consequences of prolonged wait before gallbladder surgery","volume":"84","author":"Cheruvu","year":"2002","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_7","first-page":"1247","article-title":"Contemporary outcomes of ambulatory laparoscopic cholecystectomy in patients with symptomatic cholelithiasis","volume":"137","author":"Lau","year":"2002","journal-title":"Arch. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Hamid, M., Mirtorabi, N., Ghumman, A., Khalid, A., Noormohamed, M.S., Kapoulas, S., Singhal, R., Nijjar, R., Richardson, M., and Wiggins, T. (2023). Tackling a post-COVID-19 cholecystectomy waiting list: Are we meeting the challenge?. Medicina, 59.","DOI":"10.3390\/medicina59101872"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1308\/rcsann.2023.0084","article-title":"Paradigm shift towards emergency cholecystectomy: One site experience of the Chole-QuiC process","volume":"106","author":"Hamid","year":"2024","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_10","first-page":"CD005440","article-title":"Early versus delayed laparoscopic cholecystectomy for acute cholecystitis","volume":"6","author":"Gurusamy","year":"2013","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1097\/SLA.0b013e3182a1599b","article-title":"Acute cholecystitis: Early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study)","volume":"258","author":"Gutt","year":"2013","journal-title":"Ann. Surg."},{"key":"ref_12","first-page":"E62","article-title":"Early cholecystectomy for acute cholecystitis: A population-based study","volume":"1","author":"Laupacis","year":"2013","journal-title":"Can. Med. Assoc. Open Access J."},{"key":"ref_13","unstructured":"National Institute for Health and Care Excellence (NICE) (2025, April 28). Gallstone Disease: Diagnosis and Management (CG188). Available online: https:\/\/cks.nice.org.uk\/topics\/gallstones\/management\/symptomatic-gallstones\/#:~:text=These%20recommendations%20are%20based%20on%20the%20National%20Institute,diagnosis%20and%20referral%20of%20people%20with%20symptomatic%20gallstones."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1002\/jhbp.516","article-title":"Tokyo Guidelines 2018: Flowchart for the management of acute cholecystitis","volume":"25","author":"Okamoto","year":"2018","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ram\u00edrez-Giraldo, C., Torres-Cuellar, A., and Van-Londo\u00f1o, I. (2023). State of the art in subtotal cholecystectomy: An overview. Front. Surg., 10.","DOI":"10.3389\/fsurg.2023.1142579"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.jamcollsurg.2015.09.019","article-title":"Subtotal cholecystectomy-\u201cfenestrating\u201d vs \u201creconstituting\u201d subtypes and the prevention of bile duct injury: Definition of the optimal procedure in difficult operative conditions","volume":"222","author":"Strasberg","year":"2016","journal-title":"J. Am. Coll. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"ofx036","DOI":"10.1093\/ofid\/ofx036","article-title":"Risk factors for surgical site infection after cholecystectomy","volume":"4","author":"Warren","year":"2017","journal-title":"Open Forum Infect. Dis."},{"key":"ref_19","first-page":"607","article-title":"Risk factors for wound infection after cholecystectomy","volume":"103","author":"Chuang","year":"2004","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1002\/bjs.9886","article-title":"Meta-analysis comparing early versus delayed laparoscopic cholecystectomy for acute cholecystitis: Early versus delayed laparoscopic cholecystectomy for acute cholecystitis","volume":"102","author":"Wu","year":"2015","journal-title":"Br. J. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1002\/bjs.6870","article-title":"Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis","volume":"97","author":"Gurusamy","year":"2010","journal-title":"Br. J. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1016\/j.jamcollsurg.2009.12.031","article-title":"Failure to perform cholecystectomy for acute cholecystitis in elderly patients is associated with increased morbidity, mortality, and cost","volume":"210","author":"Riall","year":"2010","journal-title":"J. Am. Coll. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1136\/gut.2005.071076","article-title":"UK guidelines for management of acute pancreatitis: Is it time to change?","volume":"54","author":"Gurusamy","year":"2005","journal-title":"Gut"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"IAP Working Group (2013). APA Acute Pancreatitis Guidelines. IAP\/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology, 13, e1\u2013e15.","DOI":"10.1016\/j.pan.2013.07.063"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/j.amjsurg.2016.04.003","article-title":"How to predict difficult laparoscopic cholecystectomy? Proposal for a simple preoperative scoring system","volume":"212","author":"Bourgouin","year":"2016","journal-title":"Am. J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1016\/j.amjsurg.2020.09.019","article-title":"Early versus delayed cholecystectomy for cholecystitis at high risk of operative difficulties: A propensity score-matching analysis","volume":"221","author":"Bourgouin","year":"2021","journal-title":"Am. J. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1097\/TA.0000000000004337","article-title":"The difficult cholecystectomy: What you need to know","volume":"97","author":"Seshadri","year":"2024","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1097\/SLE.0b013e318220f1b1","article-title":"Difficult laparoscopic cholecystectomy: Current evidence and strategies of management","volume":"21","author":"Hussain","year":"2011","journal-title":"Surg. Laparosc. Endosc. Percutan. Tech."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.amjsurg.2023.12.022","article-title":"Subtotal vs total cholecystectomy for difficult gallbladders: A systematic review and meta-analysis","volume":"229","author":"Koo","year":"2024","journal-title":"Am. J. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1007\/s00268-022-06772-x","article-title":"Timing of elective cholecystectomy after acute cholecystitis: A population-based register study","volume":"47","author":"Popowicz","year":"2023","journal-title":"World J. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"411","DOI":"10.9738\/INTSURG-D-18-00027.1","article-title":"The relationship between waiting time for elective cholecystectomy and emergency admission in KFMMC: Single centre experience","volume":"105","author":"Bshait","year":"2021","journal-title":"Int. Surg."},{"key":"ref_32","unstructured":"CholeS Study Group, West Midlands Research Collaborative (2016). Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases: Variation in the use of emergency cholecystectomy for benign gallbladder diseases. Br. J. Surg., 103, 1716\u20131726."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"6403","DOI":"10.1007\/s00464-021-08986-x","article-title":"Elective laparoscopic cholecystectomy: Recurrent biliary admissions predispose to difficult cholecystectomy","volume":"36","author":"Lucocq","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s10353-021-00722-y","article-title":"Reducing waiting lists for laparoscopic cholecystectomy: An intensive approach to aid COVID-19 recovery","volume":"54","author":"Clifford","year":"2022","journal-title":"Eur. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1002\/bjs.10317","article-title":"Cost-effectiveness of emergency versus delayed laparoscopic cholecystectomy for acute gallbladder pathology: Cost-effectiveness of emergency versus delayed laparoscopic cholecystectomy","volume":"104","author":"Sutton","year":"2016","journal-title":"Br. J. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1002\/bjs.6685","article-title":"Prospective randomized trial using cost-utility analysis of early versus delayed laparoscopic cholecystectomy for acute gallbladder disease","volume":"96","author":"Macafee","year":"2009","journal-title":"Br. J. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1308\/rcsbull.2019.190","article-title":"Lessons from the RCS quality improvement collaborative Chole-QuIC","volume":"101","author":"Bamber","year":"2019","journal-title":"Bull. R. Coll. Surg. 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