Laparoscopic Cholecystectomy: Day-Care Versus Clinical Observation

Abstract

ObjectiveTo determine the feasibility and desirability of laparoscopic cholecystectomy (LC) in day-care versus LC with clinical observation. Summary Background DataLaparoscopic cholecystectomy has been performed regularly as outpatient surgery in patients with uncomplicated gallstone disease in the United States, but this has not been generally accepted in Europe. The main objections are the risk of early severe complications (bleeding) or other reasons for readmission, and the argument that patients might feel safer when observed for one night. Quality-of-life differences hitherto have not been investigated. MethodsEighty patients (American Society of Anesthesiology [ASA] 1/11) with symptomatic gallstones were randomized to receive LC either in day-care or with clinical observation. Complications, (re)admissions, consultations of general practitioners or the day-care center within 4 days after surgery, use of pain medication, quality of life, convalescence period, time off from professional activities, and treatment preference were assessed. The respective costs of day-care and clinical observation were determined. ResultsOf the 37 patients assigned to the day-care group who underwent elective surgery, 92% were discharged successfully after an observation period of 5.7 ± 0.2 hours. The remainder of the patients in this group were admitted to the hospital and clinically observed for 24 hours.For the 37 patients in the clinical observation group who underwent elective surgery, the observation time after surgery was 31 ± 3 hours.Three patients in the day-care group and one patient in the clinical observation group had complications after surgery. None of the patients in either group consulted a general practitioner or the hospital during the first week after surgery.Use of pain medication was comparable in both groups over the first 48 hours after surgery. There were no differences in pain and other quality-of-life indicators between the groups during the 6 weeks of follow-up.Of the patients in the day-care group, 92% preferred daycare to clinical observation. The same percentage of patients in the clinical observation group preferred at least 24 hours of observation to day-care.Costs for the day-care patients were substantially lower (approximately $750/patient) than for the clinical observation patients.

Introduction of a Day-Case Laparoscopic Cholecystectomy Service in the UK: A Critical Analysis of Factors Influencing Same-Day Discharge and Contact with Primary Care Providers

“…The acceptability of same-day discharge has been reported in populations outside the UK, with satisfaction rates varying from 71-95%. 4,[17][18][19][20][21] In this study, 94% of patients were highly satisfied with the service we provided, both in the discharged and admitted groups. Sixteen significant intra-operative difficulties in 15 patients were encountered (Table 6).…”

“…Pain and nausea also appeared well controlled in our patients in comparison to published series. 4,11 To date, no authors have examined the burden on primary care providers after day-case LC. Our results indicate that 33% of patients contacted a healthcare professional within 14 days of surgery for an unplanned consultation.…”

The Impact of Patient-Controlled Analgesia on Laparoscopic Cholecystectomy

“…6 In the era of day-surgery, several studies have shown that postoperative pain following successful laparoscopic cholecystectomy can be managed by regular oral analgesia. 7,8 In a study of 84 patients, Serralta et al 9 showed that the analgesic requirement following successful laparoscopic cholecystectomy is substantially less and opioids may not play a role in postoperative pain management.…”

Transhiatal vs extended transthoracic resection in oesophageal carcinoma: patients' utilities and treatment preferences

“…However, almost all patients who underwent the transthoracic procedure would choose the extensive procedure again. This is a remarkable result, because earlier studies (Keulemans et al, 1998;Nieuwkerk et al, 1998) showed that people tend to choose the treatment they have received, even if this treatment was randomly allocated. In the present study, patients apparently want to optimise the chances that the malignant disease is definitely cured.…”

“…These choices are known as treatment preferences and typically involve informed patients Keulemans et al, 1998;Nieuwkerk et al, 1998;Awad et al, 2000). The treatment preference method is a realistic reflection of the actual decision situation.…”