Laparoscopic cholecystectomy: do risk factors for a prolonged length of stay exist?

Ripetti, V.; Luffarelli, Paolo; Santoni, Simone; Greco, S.

doi:10.1007/s13304-019-00641-4

Cited by 6 publications

(5 citation statements)

References 26 publications

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“…Understanding the relationship between preoperative factors and PLOS will improve resource utilization and address the associated cost implications. Patient age, male sex, number of comorbidities and emergency surgery have been positively associated with longer LOS; however, a larger study is necessary to investigate preoperative factors and derive a viable risk model that is specific to elective LC 16–21…”

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confidence: 99%

“…Patient age, male sex, number of comorbidities and emergency surgery have been positively associated with longer LOS; however, a larger study is necessary to investigate preoperative factors and derive a viable risk model that is specific to elective LC. [16][17][18][19][20][21] The present study determines the relationship between LOS and morbidity and then sets an appropriate cut-off to define PLOS. Following this, the study aims to identify risk factors for PLOS and both derive and validate a preoperative risk model for PLOS.…”

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confidence: 99%

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Defining Prolonged Length of Stay (PLOS) Following Elective Laparoscopic Cholecystectomy and Derivation of a Preoperative Risk Score to Inform Resource Utilization, Risk Stratification, and Patient Consent

Lucocq

Scollay²,

Patil³

2022

Annals of Surgery

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Objective: The present study defines prolonged length of stay (PLOS) following elective laparoscopic cholecystectomy (LC) and its relationship with perioperative morbidity. A preoperative risk tool to predict PLOS is derived to inform resource utilization, risk stratification and patient consent. Background: Surgical candidates for elective LC are a heterogeneous group at risk of various perioperative adverse outcomes. Preoperative recognition of high-risk patients for PLOS has implications on feasibility for day surgery, resource utilization, preoperative risk stratification, and patient consent. Methods: Data for all patients who underwent elective LC between January 2015 and January 2020 across 3 surgical centers (1 tertiary referral center and 2 satellite units) in 1 health board were collected retrospectively (n=2166). The optimal cut-off of PLOS as a proxy for operation-related adverse outcomes was found using receiver operating characteristic curves. Multivariate logistic regression was conducted on a derivation subcohort to derive a preoperative model predicting PLOS. Receiver operating characteristic curves were performed to validate the model. Patients were stratified by the risk tool and the risks of PLOS were determined. Results: A LOS of ≥3 days following elective LC demonstrated the best diagnostic ability for operation-related adverse outcomes [area under curve (AUC)=0.87] and defined the PLOS cut-off. The rate of PLOS was 6.6% (144/2166), 86.1% of which had a perioperative adverse outcome. PLOS was strongly associated with all adverse outcomes (subtotal, conversion-to-open, intraoperative complications, postoperative complication/imaging/intervention) (P<0.001). The preoperative model demonstrated good diagnostic ability for PLOS in the derivation (AUC=0.81) and validation cohorts (AUC=0.80) and stratified patients appropriately. Conclusions: Morbidity in PLOS patients is significant and pragmatic patient selection in accordance with the risk tool may help centers improve resource utilization, risk stratification, and their consent process. The risk tool may help select candidates for cholecystectomy in a strictly ambulatory/outpatient center.

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confidence: 99%

Defining Prolonged Length of Stay (PLOS) Following Elective Laparoscopic Cholecystectomy and Derivation of a Preoperative Risk Score to Inform Resource Utilization, Risk Stratification, and Patient Consent

Lucocq

Scollay²,

Patil³

2022

Annals of Surgery

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“…The mean length of stay of patients undergoing cholecystectomy in our sample was high, probably due to the inclusion of records of patients with long hospitalizations for other clinical diseases and who manifested biliary pathology during hospitalization, motivating surgery on an urgent basis or scheduled within the same hospital stay. An analysis of 985 patients who underwent laparoscopic cholecystectomy between May 2006 and February 2015 in a tertiary hospital in Italy suggested that prolonged hospital stay (defined as greater than 2 days) is not related to the surgical procedure, but to the patient’s comorbidities 22 .…”

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confidence: 99%

Incidental gallbladder cancer: what is the prevalence and how do we perform cholecystectomy for presumably benign biliary disease?

Silva

Veloso

Valadares

et al. 2022

Rev. Col. Bras. Cir.

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Objective: to determine the prevalence of incidental gallbladder cancer (IGBC) in cholecystectomies performed in a tertiary public hospital and to describe technical and epidemiological aspects of performing cholecystectomies for presumably benign disease. Method: descriptive, retrospective observational study, based on analysis of medical records of patients undergoing cholecystectomy with preoperative hypothesis of benign disease between January 2018 and January 2022. Results: prevalence of gallbladder adenocarcinoma in our sample was 0.16%, similar to data in the literature. Technical aspects during cholecystectomy were also described with a frequency similar to that found in the literature. Conclusion: despite a rare disease, IGBC is relevant in the routine of the General Surgeon. Its diagnosis, staging and treatment directly affect the prognosis. Technical aspects during cholecystectomy are not always remembered by surgeons and can interfere with the prognosis and subsequent treatment of the patient.

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“…Aspectos técnicos durante a realização da colecistectomia nem sempre são lembrados pelos cirurgiões e podem interferir no prognóstico e tratamento subsequente do paciente. (definida como maior que 2 dias) não está relacionada ao procedimento cirúrgico, mas sim às comorbidades do paciente 22 .…”

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Câncer incidental de vesícula biliar: qual a prevalência e como operamos a colecistectomia por doença presumidamente benigna?

Silva

Veloso

Valadares

et al. 2022

Rev. Col. Bras. Cir.

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RESUMO Objetivos: determinar a prevalência de câncer incidental de vesícula biliar (CIVB) em colecistectomias realizadas em um hospital público terciário e descrever aspectos técnicos e epidemiológicos na realização de colecistectomias por doença presumidamente benigna. Método: estudo observacional descritivo, retrospectivo, a partir da análise de prontuários de pacientes submetidos à colecistectomia com hipótese pré-operatória de doença benigna entre janeiro de 2018 e janeiro de 2022. Resultados: a prevalência de adenocarcinoma de vesícula biliar na amostra avaliada foi de 0,16%, semelhante aos dados da literatura mundial. Os aspectos técnicos durante a realização da colecistectomia também foram descritos com frequência semelhante ao encontrado na literatura. Conclusão: o CIVB é uma doença rara mas de importância relevante na rotina do Cirurgião Geral. Seu diagnóstico, estadiamento e tratamento implicam diretamente no prognóstico. Aspectos técnicos durante a realização da colecistectomia nem sempre são lembrados pelos cirurgiões e podem interferir no prognóstico e tratamento subsequente do paciente.

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Laparoscopic cholecystectomy: do risk factors for a prolonged length of stay exist?

Cited by 6 publications

References 26 publications

Defining Prolonged Length of Stay (PLOS) Following Elective Laparoscopic Cholecystectomy and Derivation of a Preoperative Risk Score to Inform Resource Utilization, Risk Stratification, and Patient Consent

Defining Prolonged Length of Stay (PLOS) Following Elective Laparoscopic Cholecystectomy and Derivation of a Preoperative Risk Score to Inform Resource Utilization, Risk Stratification, and Patient Consent

Incidental gallbladder cancer: what is the prevalence and how do we perform cholecystectomy for presumably benign biliary disease?

Câncer incidental de vesícula biliar: qual a prevalência e como operamos a colecistectomia por doença presumidamente benigna?

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