Warning over surgery delays for thousands of patients

Ian Beckingham, a consultant surgeon at Nottingham University Hospitals Trust and author of guidelines on treatment for gallstone related pancreatitis, was speaking after a coroner called for National Institute for Health and Care Excellence guidance to prevent more deaths

Mr Beckingham said only 15 per cent of patients with gallstone related pancreatitis had their gallbladder removed within two weeks of the occurrence, as is recommended, but 50-60 per cent of them could benefit and would be well enough for surgery. He said lack of theatres was a key reason but there was enormous variation.

He added: “If you go to France, Australia or the United States, the majority of patients get their operations on the same admission.” Twenty per cent of people on the waiting list will develop pancreatitis again, he said, and 10 per cent of severe pancreatitis patients will die.

His comments came after a prevention of future death report last week into a man who died five months after admission to the Royal Cornwall Hospital in early August 2015 with gallstone pancreatitis. Terrence George was seen as an outpatient eight weeks later and advised he needed his gallbladder removed but the consultant could not set a date for surgery because a clerk did not answer the telephone and had no answerphone.

Eventually Mr George was given a pre-operative assessment over the telephone in November 2015 and was due to have additional tests at his GP surgery on 4 January 2016. The day before this he developed pancreatitis and was treated in intensive care, dying on 7 January. He still did not have a date for surgery.

Emma Carlyon, senior coroner for Cornwall and the Isles of Scilly, said the International Association of Pancreatology and the British Society of Gastroenterology recommended gallbladder removal should be done within two weeks after a diagnosis of gallstone pancreatitis.

She said: “If performed, on balance [it] would have avoided death at this time… The treating hospital did not have an adequate system for ensuring the timeliness of gallstone surgery or to identify that Mr George had not had his operation within the recommended guidelines.”

When Royal Cornwall contacted other South West trusts at the coroner’s request, only two out of nine had local guidance setting out a pathway to surgery in such cases.

Ms Carlyon asked NICE, which is in the process of developing guidance on pancreatitis, to consider speeding this up. Her report said guidelines could lead to trusts prioritising the timing of gallbladder surgery after pancreatitis. NICE would not release its response to the coroner but said the scope of its guidelines did not cover the circumstances of Mr George’s death or the interval between operations.

Mr Beckingham said professional bodies had developed guidance and were working to increase the number of patients treated quickly, but NICE guidance would be “a stick” to encourage this.

In a statement, the trust said: “We deeply regret the delay in Mr George’s treatment. We offered our condolences to his family and made sure we learnt from the shortcomings in his care.

“Following Mr George’s death, we carried out a detailed review of his case. As a result, a new care pathway for acute gallstone pancreatitis was implemented to ensure that patients have the required surgery either during their first admission or within two weeks, as clinically appropriate. This has been in place for over a year and our audits have shown it is effectively avoiding delays for patients with this condition. At the time of the inquest, the coroner commended the comprehensive implementation of these changes by the trust.”