Day-case laparoscopic cholecystectomy: analysis of the factors allowing early discharge

Abstract

Despite a number of studies have already demonstrated that majority of patients can be safely discharged early after laparoscopic cholecystectomy, this approach did not gain widespread diffusion yet. The present study was set up to assess safety and feasibility of 24 h or same-day discharge after laparoscopic cholecystectomy and to identify the prognostic factors. Perioperative variables of 229 patients undergoing cholecystectomy have been analyzed. Primary endpoints were: postoperative length of stay, rate of patients discharged within 24 h, and rate of those discharged on the same day. Secondary endpoints were rate of 30-day readmission and rate of 30-day postoperative complications. Two-hundred twenty-three cases have been started by laparoscopy. Conversion rate was 3.1%. Overall mean postoperative stay was 1.8 ± 3.5 days (median 1 day). Seventy-eight percent of patients have been discharged within 24 h, and 22.3% have been discharged on the same day. Postoperative morbidity was 2.2%. Readmission rate was 3.9%. At univariate analysis, factors related to early discharge were age (more or less than 65), diagnosis (simple symptomatic gallstones vs complicated gallstones), ASA score, timing of operation (elective vs emergency), history of CBD stones, laparoscopic operation, and use of drain. No single factor was significantly related to readmission rate, but the use of drains in laparoscopic cases. At multivariate analysis, only elective operation, simple symptomatic gallstones, no history of CBD stones, laparoscopic approach, and no abdominal drain resulted independently associated with discharge within 24 h from the operation. The predictive models are all fit and significant. Early postoperative discharge within 24 h should be considered in all patients with simple symptomatic gallstones who had laparoscopic cholecystectomy. Same-day discharge should be considered if no drain was left at the end of the operation.

A Prospective Cohort Analysis of the Prevalence and Predictive Factors of Delayed Discharge After Laparoscopic Cholecystectomy in Italy: The DeDiLaCo Study

“…In our study, the hospital readmission rate was lower than in previous studies (1.2%), and low was the percentage of patients (10.5%) who accessed hospital facilities immediately after discharge. This rate compares favorably with those reported by other authors 7,9,10,20,30,43 . Interestingly, we found no difference in readmission when patients were discharged home ≤24 or >24 hours.…”

The Safety of Laparoscopic Cholecystectomy in the Day Surgery Unit Comparing with That in the Inpatient Unit: A Systematic Review and Meta-Analysis

“…Six of the 8 RCTs [32,[35][36][37][38][39] performed prophylactic analgesia to relieve PONV and postoperative pain in this study, and 12.5%-26.5% of patients experienced PONV in the day surgery group compared to 6.9%-18.2% of patients in the inpatient group. But there was no significant difference between the two groups in PONV (RR = 1:49; p = 0:24; 95% CI 0.77-2.86), which was consistent with the previous study [40,41]. The mean VAS after LC was lower in the day surgery group than that in the inpatient group.…”

Papel de la proteína C reactiva y la velocidad de sedimentación globular en la predicción de colecistectomía laparoscópica dificultosa: su aplicación en un programa de residencia universitario

“…Es sabido que las colecistectomías dificultosas presentan mayor número de complicaciones y mayor grado de severidad en la escala de Clavien-Dindo que las colecistectomías simples 14 . Además, la técnica quirúrgica entre un escenario y otro puede cambiar, requiriendo realizar colecistectomías subtotales o parciales (Zabala-Bengolea, Pribram, Doyene) 15,16 .…”

“…Difficult cholecystectomies are associated with greater number of complications, which are more severe according to the Clavien-Dindo classification than simple cholecystectomies 14 . In addition, the surgical technique between one and another scenario may change, requiring subtotal or partial cholecystectomies (Zabala-Bengolea, Pribram, Doyene) 15,16 .…”