Clinical audit: reviewing management of gallbladder and common bile duct stones at a public sector tertiary care hospital in Karachi, Pakistan

Abstract

Objectives: To evaluate adherence to the guidelines for the management of gallstones in a tertiary care setting.

Methods: The clinical audit was conducted at the General Surgical Unit VI, Civil Hospital, Karachi, and comprised data of laparoscopic cholecystectomy from October 1 to November 1, 2023. Management practices were assessed using the guidelines published by the National Institute of Health and Care Excellence. The audit conformed to the Standards for Quality Improvement Reporting Excellence 2.0 guidelines for quality improvement projects. Data was analysed using SPSS 20.

Result: Of the 62 patients, 49(79%) were females, 12(21%) were males, 18(29%) were aged 40-50 years and 17(27.4%) were aged 30-49 years. All the 62(100%) patients underwent liver function tests and an ultrasound of the abdomen. There were 26(41.9%) patients with acute cholecystitis, and 6(23%) underwent surgery within a week of diagnosis as recommended. There were 48(77.4%) symptomatic patients, and the recommended day-care admission was employed for 15(31,3%).

Conclusion: The delay in surgical intervention for acute cholecystitis warranted attention. Balancing this with resource limitations underscored the need for effective adaptive strategies to optimise patient care.

Key Words: Gallbladder, Cholecystectomy, Stones, Laparoscopy.