Prospective survey to study factors which could influence same-day discharge after elective laparoscopic cholecystectomy in a tertiary care hospital of a developing country

Abstract

All laparoscopic cholecystectomy (LC) patients in our hospital setting are admitted overnight. This article assesses the contribution of factors like postoperative nausea and vomiting (PONV), postoperative pain and surgical complications to overnight stay after elective LC. This 1-year observational study included patients having normal liver functions undergoing elective LC before 1400 h. The collected data included patient demographics, co-morbidities, PONV, pain scores, complications, surgical time, anesthesia technique, use of prophylactic antiemetics, analgesics, patient satisfaction and desire to have this surgery as day case or in-patient procedure. From 930 LC done per annum, 45.2 % (430/950) patients were included in this study. Prophylactic antiemetic was given in 91.6 %, intraoperative narcotics in 94.2 % patients and multimodal analgesia in 85.3 %. The mean pain score in the recovery and ward was maintained to <4. In the ward, 99.1 % patients were able to start oral fluids after 6 h and were started on oral non-steroidal anti-inflammatory drugs and paracetamol, and none required parental opioid. The PONV score of more than 2 was observed in only 3.2 % of patients in the ward requiring parenteral antiemetic. Surgical complications in the form of bleeding, visceral injury and bile duct leak were observed in 2 % of patients, which was treated intra-operatively. Satisfaction was observed in 99.3 % and desire to stay overnight in 87.4 % of patients. Factors like postoperative pain, PONV and surgical complications were well managed and were not associated with significant morbidity to justify routine overnight admission. However, majority of the patients desired to stay overnight, which could be improved by counseling and education.

A Bibliometric Analysis of Published Literature in Postoperative Pain in Elderly Patients in Low- and Middle-Income Countries

“…Twenty of them were duplicated and were deleted. After further evaluation of the 60 remaining papers, only 15 were included in the bibliometric data analysis [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. The main reasons for exclusion were: 28 articles-age group with adults; 4 articles-the age group with children; 6 articles-had no postoperative pain; 4 articles-evaluated chronic pain; 3 articles-addressed surgical technique and costs.…”

“…NoIsmail S.; et al[19] Prospective survey to study factors which could influence same-day discharge after elective laparoscopic cholecystectomy in a tertiary care hospital of a developing countryArticle Department of Anaesthesia, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan No Rendón G.J. ; et al…”

Efficacy and safety of local ozone injection through the surgical incision for postoperative pain in patients undergoing VATS-assisted pulmonary lobectomy：a randomized controlled trial

“…It is detrimental to the patient's postoperative recovery, and long-term opioid use may generate addiction tolerance. Many conditions can cause nausea and vomiting in patients during perioperative procedures, such as the patient's health status, smoking, anaesthesia medication, surgical stimulation, and age, with a high probability of occurrence in female patients [19,20]. Ozone is a novel analgesic adjuvant therapy.…”