ABSTRACT
OBJECTIVE: To evaluate the feasibility of an ambulatory laparoscopic cholecystectomy program. DESIGN: Prospective analysis of ambulatory cases, overnight stay percentage, unexpected admission rate, postoperative complications and readmissions. PATIENTS: 271 consecutive patients undergoing elective laparoscopic cholecystectomy. RESULTS: Ambulatory laparoscopic cholecystectomy was completed in 193 out of 271 patients, reaching a 71.2 percent for the whole series. Ambulatory patients increased along with the experience of the team from a 22.9 percent in 1997 to 91.4 per cent in 2000. Sixty four patients (23.6%) had to be hospitalized overnight. Finally 14 patients had to be admitted (5.2%). The percentage of postoperative complications was 7.7%. CONCLUSIONS: Ambulatory laparoscopic cholecystectomy is a feasible and safe procedure with no increase in morbidity that can be performed in up to 90 per cent of patients.
Subject(s)
Ambulatory Surgical Procedures , Cholecystectomy , Adult , Aged , Female , Humans , Male , Middle Aged , Prospective Studies , Time FactorsABSTRACT
Objetivo: evaluación de la capacidad de implantación y éxito de un programa de colecistectomía laparoscópica ambulatoria. Diseño del estudio: evaluación prospectiva de índice de sustitución, porcentaje de estancia "de una noche", porcentaje de ingresos no esperados, incidencia de complicaciones postoperatorias e índice de reingresos. Pacientes: 271 colecistectomías laparoscópicas electivas consecutivas. Resultados: el índice de sustitución pasó de un 22,9 por ciento del primer año a un 91,4 por ciento en el ultimo año, alcanzando un 71,2 por ciento para el global de la serie (193/271). En 64 pacientes se precisó régimen de estancia "de una noche" (23,6 por ciento de la serie). En tan sólo 14 casos fue necesario el ingreso de los pacientes (5,2 por ciento de la serie). El porcentaje de complicaciones postoperatorias fue del 7,7 por ciento. Conclusiones: la colecistectomía ambulatoria es factible hasta en más de un 90 por ciento de los pacientes, no suponiendo este nuevo sistema un incremento en la tasa de complicaciones (AU)
Subject(s)
Middle Aged , Adult , Aged , Male , Female , Humans , Cholecystectomy , Ambulatory Surgical Procedures , Time Factors , Prospective StudiesABSTRACT
Low molecular weight heparins are a group of drugs that have only recently been introduced in clinical practice. The are widely used for prophylaxis in thromboembolic disease and are being employed increasingly to treat established venous thrombosis. One way in which these drugs are often used is for prophylaxis in the perioperative period for patients at high risk of developing venous thromboembolism, and the anesthesiologist must therefore be familiar with the main aspects of this application. We review pharmacological characteristics of these drugs as well as the literature on low molecular weight heparins, stressing points of main interest to the anesthesiologist and intensive care recovery unit specialist, namely adverse effects (mainly bleeding) and the implications that use of low molecular weight heparin will have on choice of anesthetic (in particular the dilemma of whether to use local/regional anesthesia).
