Developing a fast- track pre-assessment pathway for laparoscopic cholecystectomy

Abstract Aims To develop a safe and reliable assessment process for patients undergoing laparoscopic cholecystectomy and negate the need for formal pre- assessment. Methods A system consisting of a health screening questionnaire completed by patients (previous general anaesthesia, cardiac and respiratory history, bleeding disorders and medications) along with a functional capacity assessment (Duke Activity Status Index), allied with screening blood tests was developed. Only patients who passed all 3 components were fast-tracked to surgery while the remainder proceeded to formal pre-assessment. Results Data was collected and analyzed on 90 consecutive patients. An interim analysis identified the format of some questions needed to be altered to facilitate patient completion, resulting in 59% (rather than 36%) of patients successfully fulfilling the fast-track criteria and not excluded by incomplete entries. Overall, 40 of the 90 patients (44%) successfully completed the fast-track assessment of whom 38 underwent surgery (2 waiting). Six patients incorrectly passed the assessments due to misinterpretation of the Duke Activity Status Index but proceeded to surgery. All 38 patients had an uneventful peri-operative course. 45 of the 50 patients who failed fast-track assessments subsequently passed formal nurse-led pre-assessment, as did 4 of the remaining 5 patients after anaesthetic review – all had an uneventful peri-operative course. Conclusion Pre-assessment driven by a health screening questionnaire, activity index and simple blood tests is safe, reduced formal pre-assessment by 44% and avoids delays. Such tools may have a significant resource impact in appropriate patient populations. The health screening questionnaire needs further revision.