Introduction The peri-operative management of biliary disease (BD) is variable across institutions with sub-optimal outcomes for patients and health systems. This results in inefficient utilisation of limited resources. The aim of the current study was to identify modifiable factors impacting patients time to theatre, intraoperative time and time to discharge as the constituents of length of stay to guide creation of a peri-operative management protocol to address this variability. Methods Data were prospectively captured at Christchurch Hospital for all adult patients presenting for cholecystectomy between May 2015 and May 2022. Pre, post and intra-operative factors were assessed for their impact on time to theatre, operative time, and post-operative hours to discharge. Results 4577 patients underwent cholecystectomy during the study period, of which 2807 (61%) were acute presentations and made up the cohort for analysis. Time to theatre was significantly impacted by pre-operative imaging type, while operative grade and the procedure type had the most clinically significant impact on operative time. Post operatively time to discharge was significantly impacted by drain placement. Conclusions Standardising management of biliary disease would likely result in significant savings for the health care system and improved outcomes for patients. The data seen here evidence the importance of appropriate imaging selection, intra-operative difficulty operative grade identification and low suction drain selection. These data have been incorporated in a perioperative management protocol as standardisation of care across the patient workflow in biliary disease is a sensible approach to ensuring optimal use of scarce resources.