Publication:

Initial outcomes of a surgical ambulatory pathway for right upper quadrant pain

Background Right upper quadrant (RUQ) abdominal pain is a common emergency presentation. Ambulatory care pathways (ACP) are described as management strategies to reduce hospital bed pressure. ACP allows well patients presenting out of hours to be discharged from the emergency department, with a plan for re-presentation for further management. The aim of this study is to demonstrate that select patients with RUQ pain can be managed via ACP to achieve shorter inpatient length of stay (LOS) without higher morbidity or mortality.

Methods Prospective data on eligible patients treated via ACP for RUQ pain between June 2021 and 2022 were compared with a retrospectively collected matched cohort of inpatient care pathway (ICP) patients from June 2019 to June 2020. Data collected included patient demographics, diagnosis, LOS, complications, and readmissions within 30 days.

Results Patients on the ACP had significantly shorter LOS (p<0.001) with a median LOS of 1.0 (IQR 0.0-1.30) compared to patients on the ICP with a median of 2.0 (IQR 1.25-2.75). There were no significant differences in patient demographics, theatre access, surgical complications, or readmissions within 30 days.

Conclusions Patients who presented out of hours with RUQ pain treated through the ACP had a shorter LOS without increased morbidity or mortality. ACP management of RUQ pain appears safe for patients who meet strict criteria.