62 (6.1 per cent) elective and 27 (14.5 per cent) emergency laparoscopic procedures were converted to open. 329 (32.5 per cent) elective cholecystectomies Wortmannin manufacturer were performed as a day case, with an average readmission rate of 4.0 per cent. The number of patients primarily listed for a day-case cholecystectomy increased from 356 in 2006 to 477 in 2008. The laparoscopic rate and day-case rates both increased, with no change in either conversion or readmission rate (Figure 3). Figure 3 Daycase, conversion and readmission rates following laparoscopic cholecystectomy between January 2006 and June 2009. Table 1 Surgical factors relating to cholecystectomies performed between 2006 and 2008. 3.1. Interim Audit (2 September�C31 October 2008) 72 patients underwent cholecystectomy during this period with a mean (range) age of 48 (18�C85) years.
19 (26 per cent) were male and 53 (74 per cent) female. 28 (39 per cent) had been listed from a routine surgical outpatient clinic, 27 (38 per cent) from the new specialist-led gallbladder clinic, and 17 (23 per cent) following an emergency admission. 44 (61 per cent) patients were listed as day cases and 28 (39 per cent) for inpatient stay. 6 (9 per cent) patients required conversion to open, of which 3 had previously had an emergency admission. 24 (33 per cent) patients were discharged on the day of surgery. 48 (67 per cent) patients required an inpatient stay, of which 18 would have been suitable for day-case surgery had they not been scheduled on an afternoon operating list. This led to the changes outlined in Table 2.
Table 2 Changes made to gallbladder pathway following interim audit in 2008. Following the above changes, the day-case rate increased to 61 per cent in June 2009, with no significant change in laparoscopic, readmission, or conversion rates observed (Figure 3). The number of emergency cholecystectomies performed remained unchanged at around 80 cases per year. 3.2. Patient Questionnaire 19 patients returned the patient questionnaire. Overall satisfaction with the service was scored as excellent (n = 12), good (n = 5), average (n = 1), and poor (n = 1). The patient scoring ��average�� had queued outside the ward with other patients on the morning of surgery and the patient scoring ��poor�� had postoperative pain. No postoperative wound complications were reported. 4.
Discussion In the present study the day-case rate following laparoscopic cholecystectomy increased fivefold following the introduction of a new streamlined gallbladder patient pathway, with no associated increase in either conversion rate or readmission rate. Expanding the criteria for day-case surgery and ensuring that patients were scheduled on morning operating lists increased this day-case rate further to 60 per cent. Entinostat Day-case laparoscopic cholecystectomy can save costs and has been shown to be a safe and effective treatment for symptomatic gallstones [3�C6].