Management of symptomatic gallstone disease: Equity between two healthcare delivery systems in Trinidad & Tobago

ABSTRACT

Objective: Patients with symptomatic gallstones require laparoscopic cholecystectomy (LC) to remove the gallbladder to avoid complications. LC should be performed with as little delay as possible. We sought to determine whether the health care delivery systems in Trinidad & Tobago were adhering to best practices. Design and Methodology: At a public and a private institution, the general surgical operating theatre registers were reviewed for the period Jan 2016 to Aug 2018 to identify all patients having undergone LC. Hospital records were then retrieved and retrospectively reviewed. The following data were extracted patient demographics, index diagnosis, date of index diagnosis, interval between index diagnosis and LC, complications between index diagnosis and LC, duration of LC, complications after LC. Results: 98 patients were studied from both centers with a mean age of 44.8 years ± 12.4(SD) and 92.8% were female. The most common indication for cholecystectomy overall was biliary colic (31.6%). For patients with biliary colic, the mean waiting time for LC was 289.3 days ± 521.5 (SD) days at the public institution compared to 9 days ± 6 (SD). Acute cholecystitis accounted for 30% of diagnoses at both centers. The mean waiting times for patients who presented with acute cholecystitis was 392.9 ± 876.2 days (mean ± SD) in the public healthcare system vs 26.1 ±27.3 days (mean ± SD) in the private healthcare system. Conclusions: There is some disparity in management of symptomatic gallstones between the private and public healthcare systems in Trinidad & Tobago. Specifically, a statistically significant difference in waiting times to complete LC exists between the systems.