Guillermo Soler-Dorda1, Enrique San Emeterio Gonzalez2, Paula Martón Bedia2. 1. Servicio Cántabro de Salud, Sección de Cirugía General y Digestiva, Hospital Comarcal de Laredo, Laredo, Cantabria, España. Electronic address: gsolerdorda@telefonica.net. 2. Servicio Cántabro de Salud, Sección de Cirugía General y Digestiva, Hospital Comarcal de Laredo, Laredo, Cantabria, España.
Abstract
INTRODUCTION: Laparoscopic cholecystectomy (LC) performed as day-case (DC) surgery has more unexpected admissions than most day-case procedures. We revised the literature about factors associated with unexpected admissions in LC as well as reconversion to open laparotomy and we investigate these factors in our series. METHODS: Retrospective cohort study, period 1999-2013 (511 cases). We study factors that in the literature have been associated with unpredicted admissions in DC or reconversion. RESULTS: In the period 1999-2013 511 patients were included (166 male/345 female), median age 53 years. Surgical indication was: Symptomatic cholelithiasis (386 cases), previous episode of cholecystitis (52 cases), biliary pancreatitis (47 cases) and ERCP for common duct stones (11 cases). 70% were discharged on the same day, 13% overnight and 17% stayed longer than 24 hours. Reconversion rate was 3.3%, readmission rate 2.8% and reoperation rate 1.2%. Bivariant study showed significant statistical association with age 65 or, ASA classification II or higher, previous admission for acute cholecystitis and logistic regression showed them to be significantly associated with readmission (sensibility: 10.6%, specificity: 98.6%, R2 coefficient: 0.046-0.066). CONCLUSIONS: The model's predictive capacity is null. We think that factors other than indications are responsible for the high proportion of failure showed by LC in DC.
INTRODUCTION: Laparoscopic cholecystectomy (LC) performed as day-case (DC) surgery has more unexpected admissions than most day-case procedures. We revised the literature about factors associated with unexpected admissions in LC as well as reconversion to open laparotomy and we investigate these factors in our series. METHODS: Retrospective cohort study, period 1999-2013 (511 cases). We study factors that in the literature have been associated with unpredicted admissions in DC or reconversion. RESULTS: In the period 1999-2013 511 patients were included (166 male/345 female), median age 53 years. Surgical indication was: Symptomatic cholelithiasis (386 cases), previous episode of cholecystitis (52 cases), biliary pancreatitis (47 cases) and ERCP for common duct stones (11 cases). 70% were discharged on the same day, 13% overnight and 17% stayed longer than 24 hours. Reconversion rate was 3.3%, readmission rate 2.8% and reoperation rate 1.2%. Bivariant study showed significant statistical association with age 65 or, ASA classification II or higher, previous admission for acute cholecystitis and logistic regression showed them to be significantly associated with readmission (sensibility: 10.6%, specificity: 98.6%, R2 coefficient: 0.046-0.066). CONCLUSIONS: The model's predictive capacity is null. We think that factors other than indications are responsible for the high proportion of failure showed by LC in DC.