An audit of ambulatory laparoscopic cholecystectomy in a Singapore institution: are we ready for day-case laparoscopic cholecystectomy?

Kow, Alfred Wei Chieh; Tan, A. P. K.; Chan, Siew Pang; Lee, Sow Fong; Chan, Chung Yip; Liau, Kui Hin; Ho, Choon Kiat

doi:10.1080/13651820802392312

Cited by 11 publications

(8 citation statements)

References 29 publications

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“…In this study in a high-volume LC setting in a specialist DGH unit, three-quarters (75.8%) of our planned day case patients were discharged on the same day, which gives an excellent ‘true day case' rate which is significantly higher than previous reports in the literature [ 5 , 8 , 9 , 11 , 13 – 19 ].…”

Section: Discussionmentioning

confidence: 58%

“…Many centres employ stringent or ‘absolute' criteria for selection of patients for day case LC [ 21 , 24 , 25 ]. The common exclusion criteria are age more than 70 years, BMI > 35 kg/m 2 , ASA grade 3 or more, complicated biliary disease (evidence of common bile duct stones or previous endoscopic retrograde cholangiogram, severe pancreatitis, and recurrent admissions with cholecystitis), previous extensive abdominal surgery, or a history of severe postoperative nausea and vomiting [ 8 , 26 ]. Tescani et al published a systematic review of 20 randomised controlled trials published on day case LCs between January 2000 and June 2008.…”

Section: Discussionmentioning

confidence: 99%

“…There is still ambiguity in the way the day case LC data is presented in the literature, with considerable confusion between the so-called ‘23-hour' stay and true day cases where the patient is discharged on the same day of surgery [ 7 , 8 ]. The definition of ‘true day case' procedure as per BADS guidelines is as follows: a patient is admitted, has a procedure performed, requires recovery facilities, and is discharged on the same day and does not stay overnight in the hospital [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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‘True Day Case’ Laparoscopic Cholecystectomy in a High-Volume Specialist Unit and Review of Factors Contributing to Unexpected Overnight Stay

Solodkyy

Hakeem

Oswald

et al. 2018

Minimally Invasive Surgery

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Introduction Laparoscopic cholecystectomy (LC) is the gold standard treatment for gallstones. British Association of Day Case Surgery recommends at least 60% of LCs be performed as day cases. The aim of this study was to assess our rate of true day case LCs and review factors preventing same-day discharge. Methods We prospectively collected data of all elective LCs performed in a district general hospital over 32 months. Results 500 patients underwent LC during this period; 438 (88.2%) patients were planned day cases and 59 patients (11.8%) planned overnight stays. Of the planned day cases, 75.8% (n=332) were discharged on the same day and 106 (24.2%) had unexpected overnight stay (UOS). Most patients with BMI >35 and ASA3 planned day case patients were successfully discharged. Drain insertion, longer operations, and late recovery departure were the main reasons for UOS. There were more complications in this group compared to day cases. Conclusions This unit has a high ‘true day case' rate of 75.8%. High BMI and ASA3 should not be absolute contraindications to day case surgery. The majority of unexpected overnight stays are unavoidable but may be reduced by patient selection, stringent preoperative assessment, operation scheduling, and reduction in unnecessary drain insertion.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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‘True Day Case’ Laparoscopic Cholecystectomy in a High-Volume Specialist Unit and Review of Factors Contributing to Unexpected Overnight Stay

Solodkyy

Hakeem

Oswald

et al. 2018

Minimally Invasive Surgery

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“…Interestingly, a recent publication found that the need for laparoscopic bile duct exploration at the time of LC in adults did not influence same-day discharge. 15 A cornerstone of DCLC practice is adequate pain management. An interesting but surprising finding of our audit was that discharge following LC was delayed in those patients who had morphine delivered via a patient-controlled device.…”

Section: Discussionmentioning

confidence: 99%

“…A relatively recent development has been the introduction of day-case LC (DCLC) in adult practice in the 1990s and there is an abundance of reports promoting its use. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] DCLC is now listed on the British Association of Day Surgery 16 and the Audit Commission 17 list of procedures. Important considerations in determining therapeutic modality in the 21st century are clinical outcomes, patient choice and satisfaction, and cost-effectiveness.…”

Section: Introductionmentioning

confidence: 99%

Day-Case Laparoscopic Cholecystectomy in Childhood: Outcomes from a Clinical Care Pathway

2012

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Aim The aim of this study was to report clinical outcomes following the use of a pediatric day-case laparoscopic cholecystectomy (DCLC) clinical care pathway. The pathway was modified in September 2009 and we compare the clinical outcomes before and after this modification. Methods A care pathway for DCLC was introduced in 2008 with emphasis on the day of admission, timing of surgery, choice of anesthetic agents, analgesia, postoperative feeding, mobilization, and pain scoring. Demographic and clinical data were recorded prospectively from

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Utility of a Novel Scale to Assess Readiness for Discharge After Bariatric Surgery

et al. 2021

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Background The safe release of a patient from hospital care after bariatric surgery depends upon the achievement of satisfactory health status. Here, we describe a new objective scale (the Readiness for Discharge, RFD Scale) to measure the patient's suitability for hospital discharge after bariatric surgery. Methods We conducted a retrospective, observational analysis of data collected in a randomized clinical trial of an enhanced recovery after surgery protocol for laparoscopic sleeve gastrectomy from 3/15/2018 to 1/12/2019. Nursing staff assessed 122 patients every 4-8 h after surgery using a checklist to document 5 components: ambulation, vital signs, pain, nausea, and oral intake of clear fluid. Satisfaction of each component was scored as ''1'' (satisfactory) or ''0'' (not satisfactory). Scores were summed and analyzed for patterns. RFD = 5 marked the patient as ready for discharge.Results Sufficient intake of clear liquid was the last RFD component satisfied in 87% of patients. Two overall response patterns emerged: '' Steady Progressors'' (n = 51) whose RFD score rose steadily from 0 to 5 without reversion to a lower score; and ''Oscillators'' (n = 71) who had at least one temporary decrease in RFD score on the way to attaining 5, or showed a simultaneous oscillation of components without change in RFD. Conclusions The RFD checklist allows objective scoring of medical readiness for discharge after LSG and has the potential to improve clinical communication.

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An audit of ambulatory laparoscopic cholecystectomy in a Singapore institution: are we ready for day-case laparoscopic cholecystectomy?

Abstract: Using our current inclusion criteria, we projected a success rate of at least 50% with the implementation of day-case LC. With the attendant advantages of cost savings and reduced resource utilization, it is therefore worthwhile to start it in Singapore.

Cited by 11 publications

References 29 publications

‘True Day Case’ Laparoscopic Cholecystectomy in a High-Volume Specialist Unit and Review of Factors Contributing to Unexpected Overnight Stay

‘True Day Case’ Laparoscopic Cholecystectomy in a High-Volume Specialist Unit and Review of Factors Contributing to Unexpected Overnight Stay

Day-Case Laparoscopic Cholecystectomy in Childhood: Outcomes from a Clinical Care Pathway

Utility of a Novel Scale to Assess Readiness for Discharge After Bariatric Surgery

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