HPB ambulatory clinic – a response to ease inpatient pressures during the COVID-19 pandemic?

Purpose: The COVID-19 pandemic has had a devastating impact on surgical services globally. Due to increasing demands on healthcare and attempts to minimise patients’ exposure to COVID-19, surgical admissions were avoided where possible and early discharge promoted. Specialist HPB practice including the management of necrotising pancreatitis and biliary sepsis, often requires prolonged hospital stay. To facilitate earlier discharge, a consultant-led HPB ambulatory clinic was introduced for a single clinical session per week. This study aims to review the safety and efficacy of this pilot pathway. Methods: A retrospective review of all patients seen at the ambulatory HPB clinic from September to November 2020 inclusively was performed. Patient demographics, clinical investigations, readmission rate and other outcomes were recorded. Results: 57 episodes of patient care were provided, with a mean age of 60.9 years (range 29-93). The mean number of patients requiring review per week was 4.38, and the mean number of visits per patient was 1.46 (range 1-5). Indications for review included drain management (n=28), interval imaging (n=12), early clinical review (n=11) and wound management (n=6). The most common underlying diagnosis was pancreatitis (24.4%), followed by conservatively managed cholecystitis (17.8%) and post-operative complications (22.2%). Other diagnoses included choledocholithiasis, liver abscess and trauma. The readmission rate was 6.66%, with no significant adverse events reported. Conclusion: This retrospective review demonstrates a safe pathway for the ongoing management of these complex patients, providing consultant-led specialist care in a timely fashion and with an acceptable readmission rate.