BACKGROUND: Patient selection, postoperative monitoring and discharge criteria after outpatient laparoscopic cholecystectomy (LC) are not clearly defined. METHODS: Patients scheduled for elective LC who fulfilled socioeconomic requirements for ambulatory surgery were enrolled in an open prospective study. Choledocholithiasis, ASA IV and unstable ASA III patients were excluded. Discharge was allowed after at least 6 hours if patients were conscious, asymptomatic, ambulant, with normal vital signs, no evidence of bleeding, spontaneous micturition and tolerating soft diet. RESULTS: Of the 250 patients included, 10.4% were admitted due to intraoperative causes. Of the remaining, 92% were discharged on the same day and 8.0% were admitted for pain control or postoperative anxiety/discomfort. Neither mortality or major complications were observed. Ninety-five percent of patients declared themselves satisfied. History of jaundice, common bile duct dilation on ultrasound, microlithiasis, abnormal preoperative alkaline phosphatase levels and surgeon's experience were independent predictors of admission due to intraoperative causes. No predictor of postoperative admission was identified. Cost analysis showed a benefit for ambulatory LC compared to overnight stay. CONCLUSION: Outpatient LC is feasible and safe with high patient satisfaction even with broad selection criteria. Improvements may be achieved in postoperative pain management.
BACKGROUND:Patient selection, postoperative monitoring and discharge criteria after outpatient laparoscopic cholecystectomy (LC) are not clearly defined. METHODS:Patients scheduled for elective LC who fulfilled socioeconomic requirements for ambulatory surgery were enrolled in an open prospective study. Choledocholithiasis, ASA IV and unstable ASA III patients were excluded. Discharge was allowed after at least 6 hours if patients were conscious, asymptomatic, ambulant, with normal vital signs, no evidence of bleeding, spontaneous micturition and tolerating soft diet. RESULTS: Of the 250 patients included, 10.4% were admitted due to intraoperative causes. Of the remaining, 92% were discharged on the same day and 8.0% were admitted for pain control or postoperative anxiety/discomfort. Neither mortality or major complications were observed. Ninety-five percent of patients declared themselves satisfied. History of jaundice, common bile duct dilation on ultrasound, microlithiasis, abnormal preoperative alkaline phosphatase levels and surgeon's experience were independent predictors of admission due to intraoperative causes. No predictor of postoperative admission was identified. Cost analysis showed a benefit for ambulatory LC compared to overnight stay. CONCLUSION:Outpatient LC is feasible and safe with high patient satisfaction even with broad selection criteria. Improvements may be achieved in postoperative pain management.
Authors: C D Briggs; G B Irving; C D Mann; A Cresswell; L Englert; M Peterson; I C Cameron Journal: Ann R Coll Surg Engl Date: 2009-06-25 Impact factor: 1.891