Day case laparoscopic cholecystectomy, room for improvement: A United Kingdom District General Hospital experience

ABSTRACT

Background: Laparoscopic cholecystectomy (LC) is the surgical treatment of choice for symptomatic gallstones. The current NHS innovation drive is to perform 60 % of all elective laparoscopic cholecystectomies as day cases. Methods: A retrospective data analysis was performed for all day case laparoscopic cholecystectomies in a single institution between January 2009 and December 2011. Causes of failed discharges, post-operative complications and readmission rates were recorded. Results: A total of 476 patients were listed as day-cases. 348 patients (73 %) were discharged the same day. 128 patients (27 %) were admitted, of these 89 (69.5 %) were discharged within 24 hours and 21 (16 %) were discharged within 2 days. 39 patients who failed discharge were due to pain only (30 %), 6 due to nausea & vomiting (5 °A)), 55 due to other reasons (43 %) and the remaining 28 due to a combination of symptoms. All 15 patients who had a drain inserted, stayed overnight (P < 0.001). All those patients who had a procedure lasting longer than two hours, failed same day discharge (P < 0.001). Our overall rates for complications, conversions to open and readmission were 2.5 %, 1.5 % and 1.7 % respectively. Our day case rate doubled from 22 % in 2009 to 50 °A) in 2010 and then plateaued at 48 °A) in 2011 as more emergency cases were being performed over this period. Conclusion: Day case laparoscopic Cholecystectomy is a feasible and a safe treatment for symptomatic gallstones. Patients should be listed on a morning list and drain insertion avoided whenever possible, with robust protocols for management of post-operative pain and vomiting (AU)

RESUMEN

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