The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day‐Case Cholecystectomy Using the CholeS Data Set

Abstract

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Sameday discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15-0.23), higher ASA scores (OR 0.19, 95% CI 0.15-0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58-0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48-0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34-0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of B5 was associated with 80.8% successful daycase cholecystectomy compared with 19.2% associated with a CAAD score [5 (p \ 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy.

The impact of the COVID-19 pandemic on elective laparoscopic cholecystectomy: A retrospective Cohort study

“…Whilst this target was met for patients in before the pandemic it was however, not met for patients operated during the pandemic recovery phase. However, the proportion of patients undergoing day case surgery in either group was lower than previously reported in the literature ( 7 , 12 ). Several studies identified predictors for failed discharge in day case surgery for LC.…”

Acute Cholecystitis from Biliary Lithiasis: Diagnosis, Management and Treatment

“…Recommendations on the timing of early CCY surgery range from within 2 days, within 3 days, and within 7 days of symptom onset. It was seen in the study conducted by Lau et al that the peri-operative administration of short courses of antibiotics makes early cholecystectomy for acute cholecystitis even more cost-effective [ 83 , 94 , 95 , 96 ], and the efficacy has been found to be the same as when long courses of conventional antibiotics are given to reduce post-operative septic complications. It also contributes to cost reduction, a reduction in the risk of adverse effects of antibiotics, lowered incidence of thrombophlebitis secondary to intravenous antibiotic administration, and a shortened hospital stay [ 97 ].…”

Systematic review and meta-analysis of factors which reduce the length of stay associated with elective laparoscopic cholecystectomy

“…Despite this, a recent study from the United Kingdom (UK) and Ireland report a DCLC rate of only 49%. 19 While this has improved significantly from 6.4% in the UK in 2005, 20 it remains well below the 75% target, and DCLC rates are highly variable between hospitals and health systems. 21 Patient-related factors often pose barriers to universal DCLC implementation.…”

“…21 Patient-related factors often pose barriers to universal DCLC implementation. - DCLC is less likely to be successful in older patients, male patients, those with higher ASA scores, previous acute gallstone-related admissions, and preoperative endoscopic intervention 19 ; therefore, proper patient selection is important. The most frequently cited modifiable reasons for failed discharge where DCLC was intended are uncontrolled pain, nausea, drain insertion, urinary retention, late return from theatre, and patient wishes or expectations.…”