Is standardized care feasible in the emergency setting? A case matched analysis of patients undergoing laparoscopic cholecystectomy

Abstract

BackgroundImmediate laparoscopic cholecystectomy is the accepted standard for the treatment of acute cholecystitis. The aim of the present study was to evaluate the feasibility of a standardized approach with tailored care maps for pre- and postoperative care by comparing pain, nausea and patient satisfaction after elective and emergent laparoscopic cholecystectomy.MethodsFrom January 2014 until April 2015, data on pain and nausea management were prospectively recorded for all elective and emergency procedures in the department of visceral surgery. This prospective observational study compared consecutive laparoscopic elective vs. emergency cholecystectomies. Visual analogue scales (VAS) were used to measure pain, nausea, and satisfaction from recovery room until 96 hours postoperatively.ResultsFinal analysis included 168 (79%) elective cholecystectomies and 44 (21%) emergent procedures. Demographics (Age, gender, BMI and ASA-scores) were comparable between the 2 groups. In the emergency group, patients did not receive anxiolytic medication (0% vs.13%, p = 0.009) and less postoperative nausea and vomiting (PONV) prophylaxis (77% vs. 97% p = <0.001). Perioperative pain management was similar in terms of opioid consumption (median amount of fentanyl 450ug [IQR 350-500] vs. 450ug [375-550], p = 0.456) and wound infiltration rates (24% vs. 25%, p = 0.799). Postoperative consumption of paracetamol, metamizole and opiod medications were similar between the 2 groups. VAS scores for pain (p = 0.191) and nausea (p = 0.392) were low for both groups. Patient satisfaction was equally high in both clinical settings (VAS 8.5 ± 1.1 vs. 8.6 ± 1.1, p = 0.68).ConclusionsA standardized pathway allows equally successful control of pain and nausea after both elective and emergency laparoscopic cholecystectomy.This study was retrospectively registered by March 01, 2016 in the following trial register: www.researchregistry.com (UIN researchregistry993)Electronic supplementary materialThe online version of this article (doi:10.1186/s12893-016-0194-6) contains supplementary material, which is available to authorized users.

Anaesthesia in a Toxic Environment: Pressurised Intraperitoneal Aerosol Chemotherapy: A Retrospective Analysis

“…was added to optimise pain management, but this occurred after the start of our study programme, thus explaining the 87% adherence rate. Pain scores were low thanks to a multimodal analgesic approach based on paracetamol and nonsteroidal anti-inflammatory drugs, and they were similar to those patients undergoing laparoscopic cholecystectomy ( 31 ). Only 26 (13.6%) procedures resulted in patients requiring morphine i.v.…”

Surgical teaching does not increase the risk of intraoperative adverse events

“…This standardized technique might provide useful guidance for less experienced surgeons to acquire surgical skills and to gain independency and safety even in stressful situations, i.e., management of challenging procedures during night shifts [28][29][30][31]. The present results of equal intraoperative outcomes might thus be mainly the result of standardization and structured surgical education [32][33][34].…”

Surgeons have hesitated early cholecystectomy because of cardiovascular comorbidities during adoption of guidelines

“…Early laparoscopic surgeries could also contribute to shorter hospital stays and lower medical costs of hospital stays without complication. Indeed, there is no difference in complaints such as postoperative pain and nausea between early operation and elective operation 14 . In addition, early surgery is also effective even in the elderly, who has any kind of comorbidities 15 , 16 .…”