Management of acute gallstone pancreatitis: so the story continues.

BACKGROUND: Surgical audit on management of mild acute gallstone pancreatitis at Western Health showed that non-compliance of carrying out laparoscopic cholecystectomy or endoscopic retrograde cholangiopancreatography and sphincterectomy within 4 weeks had resulted in a high readmission rate. Modification of management was then instituted and audit cycle repeated to assess the outcome.

METHODS: Medical records of patients with mild acute gallstone pancreatitis between January 2000 and February 2002 were audited. The pathology results and medical imaging suggestive of acute gallstone pancreatitis were analysed. Patients with less than three positive Ranson's criteria were included in the surgical audit. Information on the course of treatment, including method (laparoscopic cholecystectomy or endoscopic retrograde cholangiopancreatography and sphincterectomy), timing, reason of non-operation and outcome were recorded. Reasons for failing to remove stones in a timely fashion were identified and strategies to improve compliance with the guidelines were implemented. An audit was repeated 10 months later to assess changes in practice.

RESULTS: The rate of carrying out timely stone removal has improved from 57 to 82% at the follow-up audit. The readmission rate has also significantly decreased. Nevertheless, the rate of carrying out laparoscopic cholecystectomy during the original admission for suitable candidates was still at 39%.

CONCLUSION: Surgical audit has identified a need to improve in the management of mild acute gallstone pancreatitis in the Western Health system. By complying with guidelines, outcomes of patient care have improved.