Home hospitalization for the surgical and conservative treatment of acute calculous cholecystitis

Abstract

Aim: Acute calculous cholecystitis is a frequent complication of gallstones that can manifest in up to 10-15 per cent of previously asymptomatic patients. Current guidelines recommend laparoscopic cholecystectomy as the gold standard treatment; however, the presence of surgery risk factors might compel physicians to opt for conservative treatment, which is often associated with longer hospital stay. Home hospitalization could be an alternative to inpatient stay for these patients. Patients and Methods: The present study was a retrospective analysis of data from a prospective patient single-centre registry. Data from 915 patients with mild or moderate acute calculous cholecystitis, who presented in the Department of General Surgery of our hospital between 2010 and 2015, were analysed. The variables included grade of acute cholecystitis, type of treatment, use of antibiotics, inpatient stay, stay in hospital-at-home, complications, mortality, readmissions and relapse. Results: A total of 147 (16 per cent) patients were referred to hospital-at-home, while the rest completed their treatment in the hospital ward. There were no significant differences between the home hospitalization and conventional hospitalization groups in the rates of complications, mortality, readmissions, relapse and length of antibiotherapy. Home hospitalization was associated with shorter inpatient stay, but longer total hospitalization, likely due to a prolonged follow up by the home care unit. Conclusions: Home hospitalization is an effective and safe alternative to conventional hospitalization, as it provides hospital-level care and reduces the number of admissions and length of inpatient stay. The timely referral of patients to other levels of assistance, such as primary care, is needed to ensure economic benefits of home hospitalization programmes.

Failure to perform index cholecystectomy during acute cholecystitis results in significant morbidity for patients who present with recurrence

“…Although laparoscopic cholecystectomy is the technique of choice for acute cholecystitis (AC), including in elderly patients, [1][2][3][4] it is not always performed during the AC episode. A Cochrane review 5 found no significant differences between early and late laparoscopic cholecystectomy, but did find trials indicating that early laparoscopic cholecystectomy during AC seems safe and may shorten the total hospital stay.…”

Inpatient-level care at home delivered by virtual wards and hospital at home: a systematic review and meta-analysis of complex interventions and their components

“…The 69 studies included 38 (55.1%) randomised trials [ 30 – 42 , 44 , 45 , 48 – 50 , 54 – 56 , 62 – 67 , 72 , 73 , 77 – 83 , 92 – 94 , 97 , 99 , 102 – 110 , 115 – 122 , 125 – 127 , 130 – 139 ] and 31 (44.9%) non-randomised studies [ 43 , 46 , 47 , 51 – 53 , 57 – 61 , 68 – 71 , 74 – 76 , 84 – 91 , 95 , 96 , 98 , 100 , 101 , 111 – 114 , 123 , 124 , 128 , 129 ] (Table 2 and Additional file 1 : Table S2). The included RCTs were largely judged as overall low (1/38; 2.6%) and unclear risk of bias (25/38; 65.8%; Table 2 and Additional file 1 : Table S3).…”

“…Four RCTs and seven non-randomised studies reported this outcome [ 31 – 33 , 36 – 38 , 52 , 53 , 60 , 68 , 74 , 81 – 84 , 87 – 91 , 101 ]. We performed no synthesis for this outcome as the outcomes used were defined inconsistently, and outcome data were incomplete in four studies.…”

Lithiasic acute cholecystitis: application of Tokyo Guidelines in severity grading

“…Patients with severe AC were treated on an individual basis, with admission to the intensive care unit when they met the criteria. In selected cases, patients with mild AC were attended to at home by the home hospitalization services 23 .…”