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Cheng S, Lee PC, Sim JXL, Tan AS, Ng CLW, Foo AXY, Abdullah HRB, Tan JTH, Ong HS, Lim CH. Cost-savings of short stay sleeve gastrectomy and walk-in hydration clinic versus conventional inpatient care. Surg Endosc 2023; 37:8349-8356. [PMID: 37700012 DOI: 10.1007/s00464-023-10414-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/12/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE We aim to evaluate the cost-saving of the short stay ward (SSW) versus conventional inpatient care following sleeve gastrectomy (LSG). We also compared the readmission rates pre- and post-inception of the intravenous hydration clinic and analyzed the cost-savings. METHODS Patients who underwent LSG between December 2021 to March 2022 with SSW care were compared with standard inpatient care. Total costs were analyzed using univariate analysis. With a separate cohort of patients, 30-day readmission rates in the 12-months preceding and following implementation of the IV hydration clinic and associated cost-savings were evaluated. RESULTS After matching on the propensity score to within ± 0.1, 20-subjects pairs were retained. The total cost per SSW-subject was significantly lower at $13,647.81 compared to $15,565.27 for conventional inpatient care (p = 0.0302). Lower average ward charges ($667.76 vs $1371.34, p < 0.0001), lower average daily treatment fee per case ($235.68 vs $836.54, p < 0.0001), and lower average laboratory investigation fee ($612.31 vs $797.21, p < 0.0001) accounted for the difference in costs between the groups. Thirty-day readmission rate reduced from 8.9 to 1.8% after implementation of the hydration clinic (p < 0.01) with decreased 30-day readmission cost (S$96,955.57 vs. S$5910.27, p < 0.01). CONCLUSION SSW for LSG is cost-effective and should be preferred to inpatient management. Walk-in hydration clinics significantly reduced readmission rates and result in tremendous cost-savings.
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Affiliation(s)
- Stephanie Cheng
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Level 5; Academia, 20 College Road, Singapore, 169856, Singapore
| | - Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Jacqueline X L Sim
- Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore
| | - Ai Shan Tan
- Department of Dietetics, Singapore General Hospital, Singapore, Singapore
| | - Cindy L W Ng
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | - Angelina X Y Foo
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | | | - Jeremy T H Tan
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Level 5; Academia, 20 College Road, Singapore, 169856, Singapore
| | - Hock Soo Ong
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Level 5; Academia, 20 College Road, Singapore, 169856, Singapore
| | - Chin Hong Lim
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Level 5; Academia, 20 College Road, Singapore, 169856, Singapore.
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Ahmed T, Bhattacharjee SS. Randomised Controlled Clinical Trial of Combined Port Site Infiltration and Intraperitoneal Irrigation with Bupivacaine on Post Operative Pain After Laparoscopic Cholecystectomy. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03660-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Lucocq J, Scollay J, Patil P. Evaluation of Textbook Outcome as a Composite Quality Measure of Elective Laparoscopic Cholecystectomy. JAMA Netw Open 2022; 5:e2232171. [PMID: 36125810 PMCID: PMC9490496 DOI: 10.1001/jamanetworkopen.2022.32171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE A textbook outcome (TO) is a composite quality measure that incorporates multiple perioperative events to reflect the most desirable outcome. The use of TO increases the event rate, captures more outcomes to reflect patient experience, and can be used as a benchmark for quality improvement. OBJECTIVES To introduce the concept of TO to elective laparoscopic cholecystectomy (LC), propose the TO criteria, and identify characteristics associated with TO failure. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was performed at 3 surgical units in a single health board in the United Kingdom. Participants included all patients undergoing elective LC between January 1, 2015, and January 1, 2020. Data were analyzed from January 1, 2015, to January 1, 2020. MAIN OUTCOMES AND MEASURES The TO criteria were defined based on review of existing TO metrics in the literature for other surgical procedures. A TO was defined as an unremarkable elective LC without conversion to open cholecystectomy, subtotal cholecystectomy, intraoperative complication, postoperative complications (Clavien-Dindo classification ≥2), postoperative imaging, postoperative intervention, prolonged length of stay (>2 days), readmission within 100 days, or mortality. The rate of TOs was reported. Reasons for TO failure were reported, and preoperative characteristics were compared between TO and TO failure groups using both univariate analysis and multivariable logistic regressions. RESULTS A total of 2166 patients underwent elective LC (median age, 54 [range, 13-92] years; 1579 [72.9%] female). One thousand eight hundred fifty-one patients (85.5%) achieved a TO with an unremarkable perioperative course. Reasons for TO failure (315 patients [14.5%]) included conversion to open procedure (25 [7.9%]), subtotal cholecystectomy (59 [18.7%]), intraoperative complications (40 [12.7%]), postoperative complications (Clavien-Dindo classification ≥2; 92 [29.2%]), postoperative imaging (182 [57.8%]), postoperative intervention (57 [18.1%]), prolonged length of stay (>2 days; 142 [45.1%]), readmission (130 [41.3%]), and mortality (1 [0.3%]). Variables associated with TO failure included increasing American Society of Anesthesiologists score (odds ratio [OR], 2.55 [95 CI, 1.69-3.85]; P < .001), increasing number of prior biliary-related admissions (OR, 2.68 [95% CI, 1.36-5.27]; P = .004), acute cholecystitis (OR, 1.42 [95% CI, 1.08-1.85]; P = .01), preoperative endoscopic retrograde cholangiopancreatography (OR, 2.07 [95% CI, 1.46-2.92]; P < .001), and preoperative cholecystostomy (OR, 3.22 [95% CI, 1.54-6.76]; P = .002). CONCLUSIONS AND RELEVANCE These findings suggest that applying the concept of TO to elective LC provides a benchmark to identify suboptimal patterns of care and enables institutions to identify strategies for quality improvement.
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Affiliation(s)
- James Lucocq
- Department of General and Upper GI Surgery, Ninewells Hospital, Dundee, United Kingdom
| | - John Scollay
- Department of General and Upper GI Surgery, Ninewells Hospital, Dundee, United Kingdom
| | - Pradeep Patil
- Department of General and Upper GI Surgery, Ninewells Hospital, Dundee, United Kingdom
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Alqahtani AR, Elahmedi M, Amro N, Abdurabu HY, Abdo N, Alqahtani S, Boutros A, Ebishi A, Al-Darwish A. Laparoscopic Sleeve Gastrectomy as Day Case Surgery vs Conventional Hospitalization: Results of the DAYSLEEVE Randomized Clinical Trial. Surg Obes Relat Dis 2022; 18:1141-1149. [DOI: 10.1016/j.soard.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
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Abstract
BACKGROUND Elective stoma closure is a common, standardized procedure in digestive surgery. OBJECTIVE This study aimed to evaluate the feasibility of day-case surgery for elective stoma closure. DESIGN This is a prospective, single-center, nonrandomized study of consecutive patients undergoing day-case elective stoma closure. SETTING This study was performed at a French tertiary hospital between January 2016 and June 2018. PATIENTS Elective stoma closure was performed by local incision with an ASA score of I, II, or stabilized III. OUTCOME MEASURES The primary end point was the day-case surgery success rate in the overall population (all patients having undergone elective stoma closure) and in the per protocol population (patients not fulfilling any of the preoperative or perioperative exclusion criteria). The secondary end points (in the per protocol population) were the overall morbidity rate (according to the Clavien-Dindo classification), the major morbidity rate (Clavien score ≥3), and day-case surgery quality criteria (unplanned consultation, unplanned hospitalization, and unplanned reoperation). RESULTS Between January 2016 and June 2018, 236 patients (the overall population; mean ± SD age: 54 ± 17; 120 men (51%)) underwent elective stoma closure. Fifty of these patients (21%) met all the inclusion criteria and constituted the per protocol population. The day-case surgery success rate was 17% (40 of 236 patients) in the overall population and 80% (40 of 50 patients) in the per protocol population. In the per protocol population, the overall morbidity rate was 30% and the major morbidity rate was 6%. Of the 40 patients with successful day-case surgery, the unplanned consultation rate and the unplanned hospitalization rate were both 32.5%. There were no unplanned reoperations. LIMITATIONS This was a single-center study. CONCLUSION In selected patients, day-case surgery for elective stoma closure is feasible and has acceptable complication and readmission rates. Day-case elective stoma closure can therefore be legitimately offered to selected patients. See Video Abstract at http://links.lww.com/DCR/B583. RESULTADOS A CORTO PLAZO DEL CIERRE DE ESTOMA AMBULATORIO UN ESTUDIO OBSERVACIONAL Y PROSPECTIVO ANTECEDENTES:El cierre electivo de un estoma es un procedimiento común y estandarizado en cirugía digestiva.OBJETIVO:Evaluar la viabilidad de la cirugía ambulatoria para el cierre electivo de estomas.DISEÑO:Un estudio prospectivo, unicéntrico, no aleatorizado de pacientes consecutivos sometidos a cierre de estoma electivo ambulatorio.ESCENARIO:Un hospital terciario francés entre enero de 2016 y junio de 2018.PACIENTES:Cierre electivo de estoma realizado por incisión local con una puntuación de la American Society of Anesthesiologists de I, II o III estabilizado.PRINCIPALES MEDIDAS DE RESULTADO:El resultado principal fue la tasa de éxito de la cirugía ambulatoria en la población general (todos los pacientes habiendo sido sometidos a cierre de estoma electivo) y en la población por protocolo (pacientes que no cumplían con ninguno de los criterios de exclusión preoperatorios o perioperatorios). Los resultados secundarios (en la población por protocolo) fueron la tasa de morbilidad general (según la clasificación de Clavien-Dindo), la tasa de morbilidad mayor (puntuación de Clavien ≥ 3) y los criterios de calidad de la cirugía ambulatoria (consulta no planificada, hospitalización no planificada y reoperación no planificada).RESULTADOS:Entre enero de 2016 y junio de 2018, 236 pacientes (la población general; edad media ± desviación estándar: 54 ± 17; 120 hombres (51%)) se sometieron al cierre electivo del estoma. Cincuenta de estos pacientes (21%) cumplieron todos los criterios de inclusión y constituyeron la población por protocolo. La tasa de éxito de la cirugía ambulatoria fue del 17% (40 de 236 pacientes) en la población general y del 80% (40 de 50 pacientes) en la población por protocolo. En la población por protocolo, la tasa de morbilidad general fue del 30% y la tasa de morbilidad mayor fue del 6%. De los 40 pacientes con cirugía ambulatoria exitosa, la tasa de consultas no planificadas y la tasa de hospitalización no planificada fueron ambas del 32.5%. No hubo reoperaciones no planificadas.LIMITACIONES:Este fue un estudio de un solo centro.CONCLUSIÓN:En pacientes seleccionados, la cirugía ambulatoria para el cierre electivo de estoma es factible y tiene tasas aceptables de complicaciones y reingreso. Por lo tanto, se puede ofrecer legítimamente el cierre electivo ambulatorio de estoma a pacientes seleccionados. Consulte Video Resumen en http://links.lww.com/DCR/B583.
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Balciscueta I, Barberà F, Lorenzo J, Martínez S, Sebastián M, Balciscueta Z. Ambulatory laparoscopic cholecystectomy: Systematic review and meta-analysis of predictors of failure. Surgery 2021; 170:373-382. [PMID: 33558068 DOI: 10.1016/j.surg.2020.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Outpatient laparoscopic cholecystectomy has proven to be a safe and cost-effective technique; however, it is not yet a universally widespread procedure. The aim of the study was to determine the predictive factors of outpatient laparoscopic cholecystectomy failure. METHOD A systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis methodology. MEDLINE, Cochrane Library, Ovid, and ISRCTN Registry were searched. The main variables were demographic (age, sex), clinical (weight, American Society of Anesthesiologists classification, previous complicated biliary pathology, history of abdominal surgery in supramesocolic compartment, gallbladder wall thickness), and surgical factors (operative time, afternoon surgery). The secondary variables were the prevalence rates of outpatient laparoscopic cholecystectomy failure due to pain or postoperative nausea and vomiting. RESULTS Fourteen studies (4,194 patients) were included, with a mean outpatient laparoscopic cholecystectomy failure rate of 23.4%. The predictors of outpatient laparoscopic cholecystectomy failure were: age ≥65 years (odds ratio: 2.34; 95% confidence interval, 1.42-3.86; P = .0009), body mass index ≥30 (odds ratio: 1.6; 95% confidence interval, 1.05-2.45; P = .03), American Society of Anesthesiologists score ≥III (odds ratio: 2.89; 95% confidence interval, 1.72-4.87; P < .0001), previous complicated biliary pathology (odds ratio: 2.39; 95% confidence interval, 1.40-4.06; P = .001), gallbladder wall thickening (odds ratio: 2.33; 95% confidence interval, 1.34-4.04; P = .003), surgical time exceeding 60 minutes (mean difference: -16.03; 95% confidence interval,-21.25 to -10.81; P < .00001), and the beginning of surgery after 1:00 pm (odds ratio: 4.20; 95% confidence interval, 1.97-11.96; P = .007). Sex (odds ratio: 1.07; 95% confidence interval, 0.73-1.57, P = .73) and history of abdominal surgery in the supramesocolic compartment (odds ratio: 2.32; 95 confidence interval, 0.92-5.82, P = .07) were not associated with outpatient laparoscopic cholecystectomy failure. CONCLUSION Our meta-analysis allowed us to identify the predictors of outpatient laparoscopic cholecystectomy failure. The knowledge of these factors could help surgeons in their decision-making process for the selection of patients who are suitable for outpatient laparoscopic cholecystectomy.
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Affiliation(s)
- Izaskun Balciscueta
- Department of General and Digestive Surgery, La Ribera University Hospital, Alzira, Valencia, Spain.
| | - Ferran Barberà
- Department of Gynecology and Obstetrics, La Fe University Hospital, Valencia, Spain
| | - Javier Lorenzo
- Department of General and Digestive Surgery, La Ribera University Hospital, Alzira, Valencia, Spain
| | - Susana Martínez
- Department of General and Digestive Surgery, La Ribera University Hospital, Alzira, Valencia, Spain. https://twitter.com/sussana24
| | - Maria Sebastián
- Department of General and Digestive Surgery, La Ribera University Hospital, Alzira, Valencia, Spain
| | - Zutoia Balciscueta
- Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
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Safety of outpatient adrenalectomy across 3 minimally invasive approaches at 2 academic medical centers. Surgery 2020; 169:145-149. [PMID: 32409169 DOI: 10.1016/j.surg.2020.03.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/17/2020] [Accepted: 03/24/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Outpatient adrenalectomy has the potential to decrease costs, improve inpatient capacity, and decrease patient exposure to hospital-acquired conditions. Still, the practice has yet to be widely adopted and current studies demonstrating the safety of outpatient adrenalectomy are limited by sample size, extensive exclusion criteria, and no comparison to inpatient cases. We aimed to study the characteristics and safety of outpatient adrenalectomy using the largest such sample to date across 2 academic medical centers and 3 minimally invasive approaches. METHODS All minimally invasive adrenalectomies were identified, starting from the time outpatient adrenalectomy was initiated at each institution. Cases involving removal of other organs, bilateral adrenalectomies, and cases in which a patient was admitted to the hospital before the day of surgery were excluded. Patient, tumor, and case characteristics were compared between outpatient and inpatient cases, and multivariable regression analysis was used to assess odds of 30-day readmission and/or complication. RESULTS Of 203 patients undergoing minimally invasive adrenalectomy, 49% (n = 99) were performed on an outpatient basis. Outpatient disposition was more likely in the setting of lower estimated blood loss, case completion before 3 pm, and for surgery performed in the setting of nodule/mass and primary hyperaldosteronism versus Cushing's syndrome, pheochromocytoma, and metastasis (P < .05). There were no significant differences in patient age, body mass index, American Society of Anesthesiologists class, procedure performed, or total time under anesthesia between inpatient and outpatient cases. On adjusted analysis, outpatient adrenalectomy was not associated with increased 30-day readmission rate (odds ratio 0.23 [confidence interval 0.04-1.26] P = .09) or 30-day complication rate (odds ratio 0.21 [confidence interval 0.06-0.81] P = .02). CONCLUSION Outpatient adrenalectomy can be performed safely without increased risk of 30-day complications or readmission in appropriately selected candidates.
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Gastric sleeve resection as day-case surgery: what affects the discharge time? Surg Obes Relat Dis 2019; 15:2018-2024. [DOI: 10.1016/j.soard.2019.09.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/06/2019] [Accepted: 09/15/2019] [Indexed: 11/16/2022]
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Rebibo L, Dhahri A, Badaoui R, Hubert V, Lorne E, Regimbeau JM. Laparoscopic sleeve gastrectomy as day-case surgery: a case-matched study. Surg Obes Relat Dis 2019; 15:534-545. [DOI: 10.1016/j.soard.2019.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 11/07/2018] [Accepted: 02/11/2019] [Indexed: 12/25/2022]
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Rebibo L, Maurice KK, Nimier M, Ben Rehouma M, Montravers P, Msika S. Laparoscopic sleeve gastrectomy as day-case surgery: a review of the literature. Surg Obes Relat Dis 2019; 15:1211-1217. [PMID: 31060908 DOI: 10.1016/j.soard.2019.03.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/03/2019] [Accepted: 03/10/2019] [Indexed: 10/27/2022]
Abstract
Day-case surgery (DCS) in digestive surgery is a hot topic, and new indications for DCS in the field of gastrointestinal surgery have recently been described. Laparoscopic sleeve gastrectomy (LSG) has become a popular bariatric procedure in recent years. LSG is a reproducible, standardized procedure with a short operating time and possibly simple perioperative management. It therefore meets the criteria to be performed as a DCS procedure. Recently published series of LSG as DCS have demonstrated its feasibility. In this review on LSG performed as DCS, we focused on the management of risks associated with DCS and the results of such type of management. A literature search was conducted in the PubMed and Embase databases. Six studies were selected, comprising a total of 6227 patients. Most published series were retrospective single-center studies. Inclusion criteria were similar between most studies (primary sleeve gastrectomy for most series, patients with a body mass index ≥40 kg/m2 or a body mass index ≥35 kg/m2 in the presence of co-morbidities), while exclusion criteria were based on literature data for some studies (using series on risk factors for morbidity and mortality after Roux-en-Y gastric bypass) and personal experience for other series. The mortality rate of LSG as DCS ranges 0%-.08%, while the overall complication rate ranges 0%-10%. The unplanned overnight admission rate after LSG ranges .8%-8%. The unscheduled hospitalization rates range 2.1%-8.5%. LSG performed as DCS is feasible with good results, but cannot be proposed for all patients. Good selection is necessary in others to avoid increased risk of morbidity and mortality.
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Affiliation(s)
- Lionel Rebibo
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, Paris, France; Université Paris Diderot - Sorbonne Paris Cité, Paris, France
| | - Karim K Maurice
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, Paris, France; Department of General and Digestive Surgery, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Martin Nimier
- Department of Anaesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, Paris, France
| | - Mouna Ben Rehouma
- Department of Anaesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, Paris, France
| | - Philippe Montravers
- Université Paris Diderot - Sorbonne Paris Cité, Paris, France; Department of Anaesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, Paris, France
| | - Simon Msika
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, Paris, France; Université Paris Diderot - Sorbonne Paris Cité, Paris, France.
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Rebibo L, Leourier P, Badaoui R, Le Roux F, Lorne E, Regimbeau JM. Minor laparoscopic liver resection as day-case surgery (without overnight hospitalisation): a pilot study. Surg Endosc 2019; 33:261-271. [PMID: 29943064 DOI: 10.1007/s00464-018-6306-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/18/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Day-case surgery (DCS) has become increasingly popular over recent years, as has laparoscopic liver resection (LLR) for the treatment of benign or malignant liver tumours. The purpose of this prospective study was to demonstrate the feasibility of minor LLR as DCS. METHODS Prospective, intention-to-treat, non-randomised study of patients undergoing minor LLR between July 2015 and December 2017. Exclusion criteria were resection by laparotomy, major LLR, difficult locations for minor LLR, history of major abdominal surgery, hepatobiliary procedures without liver parenchyma resection, cirrhosis with Child > A and/or portal hypertension, significant medical history and exclusion criteria for DCS. The primary endpoint was the unplanned overnight admission rate. Secondary endpoints were the reason for exclusion, complication data, criteria for DCS evaluation, satisfaction and compliance with the protocol. RESULTS One hundred sixty-seven patients underwent liver resection during the study period. LLR was performed in 92 patients (55%), as DCS in 23 patients (25%). Reasons for minor LLR were liver metastasis (n = 9), hepatic adenoma (n = 5), hepatocellular carcinoma (n = 4), ciliated hepatic foregut cyst (n = 2) and other benign tumours (n = 3). All day-case minor LLR, except two patients, consisted of single wedge resection, while one patient underwent left lateral sectionectomy. There were four unplanned overnight admissions (17.4%), one unscheduled consultation (4.3%), two hospital readmissions (8.6%) and no major complications/mortality. Compliance with the protocol was 69.5%. Satisfaction rate was 91%. CONCLUSION In selected patients, day-case minor LLR is feasible with acceptable complication and readmission rates. Day-case minor LLR can therefore be legitimately proposed in selected patients.
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Affiliation(s)
- Lionel Rebibo
- Department of Digestive Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France
| | - Pauline Leourier
- Department of Digestive Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France
| | - Rachid Badaoui
- Department of Anaesthesiology, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France
| | - Fabien Le Roux
- Department of Digestive Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France
| | - Emmanuel Lorne
- Department of Anaesthesiology, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France.,SSPC (Simplification des Soins des Patients Complexes) - Clinical Research Unit, University of Picardie Jules Verne, 80054, Amiens Cedex 01, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France. .,SSPC (Simplification des Soins des Patients Complexes) - Clinical Research Unit, University of Picardie Jules Verne, 80054, Amiens Cedex 01, France. .,Service de chirurgie digestive, Hôpital Sud, CHU d'Amiens, Avenue René Laennec, 80054, Amiens Cedex 01, France.
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Evaluation of patient safety and satisfaction in a program of ambulatory laparoscopic cholecystectomy program with expanded criteria. Cir Esp 2018; 97:27-33. [PMID: 30098761 DOI: 10.1016/j.ciresp.2018.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The good results obtained with the implementation of ambulatory laparoscopic cholecystectomy programs have led to the expansion of the initial inclusion criteria. The main objective was to evaluate the results and the degree of satisfaction of the patients included in a program of laparoscopic cholecystectomy without admission, with expanded criteria. METHODS Observational study of a cohort of 260 patients undergoing ambulatory laparoscopic cholecystectomy between April 2013 and March 2016 in a third level hospital. We classified the patients into 2groups based on compliance with the initial inclusion criteria of the outpatient program. Group I (restrictive criteria) includes 164 patients, while in group ii (expanded criteria) we counted 96 patients. We compared the surgical time, the rate of failures in ambulatory surgery, rate of conversion, reinterventions and mortality and the satisfaction index. RESULTS The overall success rate of ambulatory laparoscopic cholecystectomy was 92.8%. The most frequent cause of unexpected income was for medical reasons. There was no statistically significant difference between the 2groups for total surgery time, the rate of conversion to open surgery and the number of major postoperative complications Do not demostrate differences in surgical time, nor in the number of perioperative complications (major complications 1,2%), or the number of failures in ambulatory surgery, nor the number of readmissions between both groups. There was no death. 88.5% of patients completed the survey, finding no differences between both groups in the patient satisfaction index. The overall score of the process was significantly better in group ii(P=.023). CONCLUSIONS Ambulatory laparoscopic cholecystectomy is a safe procedure with a good acceptance by patients with expanded criteria who were included in the surgery without admission program.
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Cairo SB, Ventro G, Meyers HA, Rothstein DH. Influence of discharge timing and diagnosis on outcomes of pediatric laparoscopic cholecystectomy. Surgery 2017; 162:1304-1313. [DOI: 10.1016/j.surg.2017.07.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/23/2017] [Accepted: 07/27/2017] [Indexed: 01/01/2023]
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Zaafouri H, Mrad S, Khedhiri N, Haddad D, Bouhafa A, Maamer AB. [First experience with outpatient laparoscopic cholecystectomy in Tunisia]. Pan Afr Med J 2017; 28:78. [PMID: 29255548 PMCID: PMC5724953 DOI: 10.11604/pamj.2017.28.78.9564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/07/2017] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstones. There is some debate as to whether it should be performed in outpatient surgery or in one-day surgery to improve patient safety. This study aimed to evaluate the impact of laparoscopic cholecystectomy performed in outpatient surgery versus one-day surgery on standards such as mortality, serious adverse events and quality of life. METHODS We conducted a cross-sectional descriptive study in the Department of General Surgery at the Habib Thameur Hospital over the period May 2009-February 2010. We here report 67 cases of symptomatic vesical lithiasis treated with outpatient laparoscopic cholecystectomy (OLC). ASA III and IV patients, diabetic patients treated with sulfonamides or insulin, severely obese patients, patients over 65 years of age and under 18 years of age, patients with a history of major abdominal surgery, patients with suspected lithiasis of the common bile duct, acute cholecystitis or pancreatitis were excluded from the study. Patients had to reside within 50 km of the hospital and be accompanied by an adult to undergo OLC. RESULTS Seventeen patients were included and then excluded from our study because of the perioperative detection of signs of acute cholecystitis or difficulties in dissection leading to subhepatic drainage using Redon catheter at the end of the intervention. Finally, our study included 50 patients, 7 men and 43 women; the average age was 48 years. Surgery was based on the most common procedures. After leaving the recovery room, patients were conducted in the outpatient sector where they received a liquid diet. The patients were examined before 7 o'clock in the evening and discharge was established on the basis of the possibility of establishing an oral analgesic treatment, patients tolerance to liquid diet, the lack of urinary disorder, patients acceptance for discharge and analgesic and anti-inflammatory treatment if needed. Thirty-nine patients (78%) were discharged from hospital and 11 were kept in hospital. Patients > 45 years of age, anesthesia duration > 70 minutes and post operative fatigue were identified as risk factors for unsuccessful discharge. No readmission was observed. Discharged patients were satisfied with the therapeutic protocol, resulting in excellent and good outcome in the majority of cases (94%). CONCLUSION Outpatient laparoscopic cholecystectomy seems to be as safe as day surgery laparoscopic cholecystectomy having low rate of complications and of hospital readmissions in some selected patients and lower surgery costs.
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Affiliation(s)
- Haithem Zaafouri
- Service de Chirurgie Générale, Hôpital Habib Thameur, Tunis, Tunisie
| | - Skander Mrad
- Service de Chirurgie Générale, Hôpital Habib Thameur, Tunis, Tunisie
| | - Nizar Khedhiri
- Service de Chirurgie Générale, Hôpital Habib Thameur, Tunis, Tunisie
| | - Dhafer Haddad
- Service de Chirurgie Générale, Hôpital Habib Thameur, Tunis, Tunisie
| | - Ahmed Bouhafa
- Service de Chirurgie Générale, Hôpital Habib Thameur, Tunis, Tunisie
| | - Anis Ben Maamer
- Service de Chirurgie Générale, Hôpital Habib Thameur, Tunis, Tunisie
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Relucio Perez A, Angeli Delos Santos K. Outpatient laparoscopic cholecystectomy: Experience of a university group practice in a developing country. INTERNATIONAL JOURNAL OF HEPATOBILIARY AND PANCREATIC DISEASES 2017. [DOI: 10.5348/ijhpd-2016-58-oa-15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Aims: In developed countries, efforts to improve outcome and minimize costs prompted the performance of laparoscopic cholecystectomy as an outpatient procedure. In the Philippines and in most developing countries, most laparoscopic cholecystectomies are still performed on admitted patients who are discharged one or more days after the surgery. No local experience has been published in the Philippines demonstrating the safety and feasibility of outpatient laparoscopic cholecystectomy.
Materials and Methods: This study is a retrospective study investigating the outcome of outpatient performed laparoscopic cholecystectomy in the University of the Philippines, Philippine General Hospital Faculty Medical Arts Building (UP-PGH FMAB), an ambulatory surgical facility within UP-PGH. The patients were admitted to the ambulatory facility on the day of surgery, underwent laparoscopic cholecystectomy under general anesthesia and discharged on the same day.
Results: From June 2012 to June 2016, 122 patients underwent laparoscopic cholecystectomy at the UP-PGH Faculty medical arts building. There were 80 women (85%) and 42 men (15%) with a mean age of 46 years. The mean operating time was 58 minutes. The unplanned admission rate was 2.4% (two patients), one for conversion to open and two for unrelieved postoperative nausea and vomiting.
Conclusion: Outpatient laparoscopic cholecystectomy is safe and technically feasible even in developing countries. It has potential for much economical and social benefit when employed judiciously. Prospective, randomized trials must be conducted in the local setting to refine technique, standardize patient selection and address system deficiencies to allow safe performance of outpatient laparoscopy in the Philippines.
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Affiliation(s)
- Anthony Relucio Perez
- Associate Professor, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of the Philippines Manila, Philippine General Hospital and UP College of Medicine, Manila, Philippines
| | - Krista Angeli Delos Santos
- Associate Professor, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of the Philippines Manila, Philippine General Hospital and UP College of Medicine, Manila, Philippines
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Widjaja SP, Fischer H, Brunner AR, Honigmann P, Metzger J. Acceptance of Ambulatory Laparoscopic Cholecystectomy in Central Switzerland. World J Surg 2017; 41:2731-2734. [DOI: 10.1007/s00268-017-4098-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Cao J, Liu B, Li X, Leng J, Meng X, Pan Y, Dou S, Lu S. Analysis of delayed discharge after day-surgery laparoscopic cholecystectomy. Int J Surg 2017; 40:33-37. [DOI: 10.1016/j.ijsu.2017.02.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/09/2017] [Accepted: 02/18/2017] [Indexed: 11/16/2022]
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Zirpe D, Swain SK, Das S, Gopakumar CV, Kollu S, Patel D, Patta R, Balachandar TG. Short-stay daycare laparoscopic cholecystectomy at a dedicated daycare centre: Feasible or futile. J Minim Access Surg 2016; 12:350-4. [PMID: 27251816 PMCID: PMC5022517 DOI: 10.4103/0972-9941.181314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/02/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In the last decade, laparoscopic cholecystectomy (LC) has become a regular daycare surgery at many centres across the world. However, only a few centres in India have a dedicated daycare surgery centre, and very few of them have reported their experience. Concerns remain regarding the feasibility, safety and acceptability of the introduction of daycare laparoscopic cholecystectomy (DCLC) in India. There is a need to assess the safety and acceptability of the implementation of short-stay DCLC service at a centre completely dedicated to daycare surgery. PATIENTS AND METHODS Comprehensive care and operative data were retrospectively collected from a daycare centre of our hospital. Postoperative recovery was monitored by telephone questionnaire on days 0, 1 and 5 postoperatively, including adverse outcomes. RESULTS A total of 211 patients were admitted for DCLC during the period from November 2011 till November 2014, of whom 211 were discharged on the day of surgery. Two hundred and two patients could be discharged within 6 h of surgery. Mean operation time was 72 min. No patient required admission. No patient needed conversion to open surgery. Only 1 patient was re-admitted due to bilioma formation and was managed with minimal intervention. CONCLUSION The introduction of short-stay DCLC in India is feasible and acceptable to patients. High body mass index (BMI) in otherwise healthy patients and selective additional procedures are not contraindications for DCLC.
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Affiliation(s)
- Dinesh Zirpe
- Department of Surgical Gastroenterology, Apollo Hospital, Chennai, Tamil Nadu, India
| | - Sudeepta K. Swain
- Department of Surgical Gastroenterology, Apollo Hospital, Chennai, Tamil Nadu, India
| | - Somak Das
- Department of Surgical Gastroenterology, Apollo Hospital, Chennai, Tamil Nadu, India
| | - CV Gopakumar
- Department of Surgical Gastroenterology, Apollo Hospital, Chennai, Tamil Nadu, India
| | - Sriharsha Kollu
- Department of Surgical Gastroenterology, Apollo Hospital, Chennai, Tamil Nadu, India
| | - Darshan Patel
- Department of Surgical Gastroenterology, Apollo Hospital, Chennai, Tamil Nadu, India
| | - Radhakrishna Patta
- Department of Surgical Gastroenterology, Apollo Hospital, Chennai, Tamil Nadu, India
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Bueno Lledó J, Granero Castro P, Gomez i Gavara I, Ibañez Cirión JL, López Andújar R, García Granero E. Veinticinco años de colecistectomía laparoscópica en régimen ambulatorio. Cir Esp 2016; 94:429-41. [DOI: 10.1016/j.ciresp.2015.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 02/26/2015] [Accepted: 03/13/2015] [Indexed: 12/15/2022]
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Sacco Casamassima MG, Gause C, Yang J, Goldstein SD, Swarup A, Abdullah F. Safety of outpatient laparoscopic cholecystectomy in children: analysis of 2050 elective ACS NSQIP-pediatric cases. Pediatr Surg Int 2016; 32:541-51. [PMID: 27037702 DOI: 10.1007/s00383-016-3888-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Limited data exists evaluating the extent of utilization and safety of outpatient laparoscopic cholecystectomy (LC) in children. The aim of this study was to investigate the safety of outpatient LC in the pediatric population utilizing a national surgical quality improvement database. METHODS The National Surgical Quality Improvement Program-Pediatric (NSQIP-P) databases from 2012 and 2013 were queried to identify pediatric patients who underwent elective LC. Patients who underwent outpatient LC were compared with those who underwent inpatient LC. Outcomes of interest included 30-day overall morbidity, readmission, and reoperation. RESULTS A total of 2,050 LC were identified, 995 (48.5 %) were performed as an outpatient procedure and 1055 (51.5 %) as inpatient. Patients who underwent outpatient LC were more often white (79.6 vs. 69.2 %; p = <0.0001). Choledocholithiasis was more often treated in inpatient setting (12.5 vs. 1.7 %; p < 0.0001), while biliary dyskinesia was performed in outpatient setting (26.1 v. 12.6 %; p = 0.0001). Overall 30-day morbidity was greater in the inpatient group (2.5 vs. 0.8 %; p = 0.03). There were no differences in term of 30-day readmission rate and related reoperations (0.9 vs 0.3 % respectively; p = 0.09). CONCLUSION This analysis of a large multicenter dataset demonstrates that pediatric patients without significant associated comorbidities can safely undergo laparoscopic cholecystectomy as an outpatient procedure.
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Affiliation(s)
- Maria G Sacco Casamassima
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Colin Gause
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jingyan Yang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Seth D Goldstein
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Abhishek Swarup
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fizan Abdullah
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Ann & Robert H Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 63, Chicago, IL, 606011, USA.
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Laparoscopic sleeve gastrectomy as day-case surgery (without overnight hospitalization). Surg Obes Relat Dis 2014; 11:335-42. [PMID: 25614354 DOI: 10.1016/j.soard.2014.08.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 08/15/2014] [Accepted: 08/29/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Day-case surgery (DCS) has boomed over recent years, as has laparoscopic sleeve gastrectomy (SG) for the treatment of morbid obesity. The objective of this study was to evaluate the safety and feasibility of day-case SG. METHODS This was a prospective, nonrandomized study of 100 patients undergoing day-case SG from May 2011 to July 2013. All patients met the criteria for DCS and for the treatment of morbid obesity. Standard surgical, anesthetic, and analgesic protocols were used. The primary study endpoint was the unplanned overnight admission rate. Secondary endpoints were standard DCS criteria, frequency and type of complications, and satisfaction rate of performing day-case SG. The short-term postoperative course of patients undergoing day-case and conventional SG also were compared. RESULTS A total of 416 patients were screened and 100 (24%) were included. There were 8 unplanned overnight admissions. Seven unexpected consultations, 7 hospital readmissions, and 5 major complications were recorded, including 3 cases of unexpected surgery for gastric leak. At follow-up, 96% of the patients were satisfied with day-case SG. The short-term postoperative course was similar among patients undergoing DCS and conventional management. CONCLUSION In selected patients, day-case SG is feasible with acceptable complication and readmission rates. The postoperative course was similar to that observed for standard SG.
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Gautam S, Agarwal A, Das PK, Agarwal A, Kumar S, Khuba S. Evaluation of the Efficacy of Methylprednisolone, Etoricoxib and a Combination of the Two Substances to Attenuate Postoperative Pain and PONV in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Placebo-controlled Trial. Korean J Pain 2014; 27:278-84. [PMID: 25031815 PMCID: PMC4099242 DOI: 10.3344/kjp.2014.27.3.278] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 11/30/2022] Open
Abstract
Background Establishment of laparoscopic cholecystectomy as an outpatient procedure has accentuated the clinical importance of reducing early postoperative pain, as well as postoperative nausea and vomiting (PONV). We therefore planned to evaluate the role of a multimodal approach in attenuating these problems. Methods One hundred and twenty adult patients of ASA physical status I and II and undergoing elective laparoscopic cholecystectomy were included in this prospective, randomized, placebo-controlled study. Patients were divided into four groups of 30 each to receive methylprednisolone 125 mg intravenously or etoricoxib 120 mg orally or a combination of methylprednisolone 125 mg intravenously and etoricoxib 120 mg orally or a placebo 1 hr prior to surgery. Patients were observed for postoperative pain, fentanyl consumption, PONV, fatigue and sedation, and respiratory depression. Results were analyzed by the ANOVA, a Chi square test, the Mann Whitney U test and by Fisher's exact test. P values of less than 0.05 were considered to be significant. Results Postoperative pain and fentanyl consumption were significantly reduced by methylprednisolone, etoricoxib and their combination when compared with placebo (P<0.05). The methylprednisolone + etoricoxib combination caused a significant reduction in postoperative pain and fentanyl consumption as compared to methylprednisolone or etoricoxib alone (P<0.05); however, there was no significant difference between the methylprednisolone and etoricoxib groups (P>0.05). The methylprednisolone and methylprednisolone + etoricoxib combination significantly reduced the incidence and severity of PONV and fatigue as well as the total number of patients requiring an antiemetic treatment compared to the placebo and etoricoxib (P<0.05). Conclusions A preoperative single-dose administration of a combination of methylprednisolone and etoricoxib reduces postoperative pain along with fentanyl consumption, PONV, antiemetic requirements and fatigue more effectively than methylprednisolone or etoricoxib alone or a placebo.
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Affiliation(s)
- Sujeet Gautam
- Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Amita Agarwal
- Dental Surgeon, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Pravin Kumar Das
- Department of Anesthesiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Anil Agarwal
- Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sanjay Kumar
- Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sandeep Khuba
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Wright GP, Wolf AM, Ambrosi G, Dull MB, Chung MH. Patient perspectives on postoperative visits after common general operative procedures. Surgery 2013; 154:934-9; discussion 939-40. [PMID: 24008090 DOI: 10.1016/j.surg.2013.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 05/10/2013] [Indexed: 11/16/2022]
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Abstract
BACKGROUND: Laparoscopic cholecystectomy (LC) is the most commonly performed minimal invasive surgery. However, practice of its use as an ambulatory surgery in our hospital settings is uncommon. OBJECTIVE: To evaluate safety and cost effectiveness of LC as an ambulatory day care surgery. STUDY DESIGN: Quasiexperimental. SETTING: Department of surgery, Aga Khan University Hospital, Karachi, Pakistan. MATERIALS AND METHODS: Patients with uncomplicated symptomatic gallstones were selected for Ambulatory LC. They were admitted electively on the same day and operated on in the morning hours and discharged after a check by the surgeon 6–8 hrs later. RESULTS: Of fifty (n = 50) patients selected for ambulatory LC, 92% were discharged successfully after 6–8 hrs observation. No significant perioperative complications were noted. Unplanned admission and readmission rate was 8 and 2%, respectively. Cost saving for the daycare surgery was Rs. 6,200, Rs. 13,300, and Rs.22,800 per patient as compared to in patient general, semiprivate, and private ward package, respectively. CONCLUSION: Practice ambulatory LC is safe and cost-effective in selected patients with uncomplicated symptomatic gallstones.
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Affiliation(s)
- Athar Ali
- Department of Surgery, Aga Khan University, Stadium Road, Karachi, Pakistan
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Kumar S, Ali S, Ahmad S, Meena K, Chandola HC. Randomised Controlled Trial of Day-Case Laparoscopic Cholecystectomy vs Routine Laparoscopic Cholecystectomy. Indian J Surg 2013; 77:520-4. [PMID: 26730057 DOI: 10.1007/s12262-013-0906-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Accepted: 03/22/2013] [Indexed: 11/26/2022] Open
Abstract
Many randomised controlled trials conducted worldwide favours for day-case laparoscopic cholecystectomy, but questions have been raised regarding its application in developing country like ours. Hence, considering it a high time to review current practices, we conducted this trial to report our experience with day-case laparoscopic cholecystectomy and to access its feasibility and safety in our set-up. Data from 65 patients with symptomatic gallstone were randomised to perform laparoscopic cholecystectomy either as day-case procedure or as routine (conventional) procedure. Complication, quality of life, satisfaction, post-operative nausea and vomiting and pain were assessed. Ninety-seven per cent (31/32) of day-case laparoscopic cholecystectomy patients were successfully discharged with mean duration of 8.9 ± 4.54 h, which was 3.33 ± 1.45 days (72.92 ± 34.8 h) in routine (conventional) laparoscopic cholecystectomy group. There was no significant difference in complication, quality of life, satisfaction, post-operative nausea and vomiting and pain between the two groups. Day-case laparoscopic cholecystectomy is a safe, feasible and beneficial procedure in our set-up. Patient acceptance in terms of quality of life and satisfaction was similar to that of routine laparoscopic cholecystectomy.
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Affiliation(s)
- Sanjay Kumar
- Department of Surgery, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India
| | - Shadan Ali
- Department of Surgery, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India
| | - Shabi Ahmad
- Department of Surgery, M.L.N. Medical College, Swaroop Rani Nehru Hospital, Allahabad, India
| | - Kusum Meena
- Department of Surgery, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India
| | - H C Chandola
- Department of Anaesthesia, M.L.N. Medical College, Swaroop Rani Nehru Hospital, Allahabad, India
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Kaman L, Iqbal J, Bukhal I, Dahiya D, Singh R. Day Care Laparoscopic Cholecystectomy: Next Standard of Care for Gall Stone Disease. Gastroenterology Res 2011; 4:257-261. [PMID: 27957025 PMCID: PMC5139863 DOI: 10.4021/gr374w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2011] [Indexed: 12/03/2022] Open
Abstract
Background To access the feasibility, safety and success of day care laparoscopic cholecystectomy in a tertiary center in India. Methods This is a retrospective analysis of prospectively collected data between 2004 and 2009 from a tertiary center in north India. All patients of symptomatic gallstone diseases having age less than 70 years, American Society of Anesthesiologists (ASA) grade I and grade II, living within 20 Kilometers of the hospital, availability of a responsible adult care taker at home, access to a telephone and a means of transportation to hospital if needed, underwent laparoscopic cholecystectomy under the care of the two participating surgeons, were considered for day care laparoscopic cholecystectomy. Clinical and operative data were recorded prospectively. All patients were discharged 6 to 8 hours after surgery with the advice to contact the surgical team over phone whenever necessary or on the day after discharge. Results A total of 602 laparoscopic cholecystectomies were performed over a period of 6years, among them 309 (51.32%) were operated on day care basis. Nine patients in day care procedure group had conversion to open procedure (5 due to distorted anatomy of calot’s triangle, 2 due to common bile duct stones, 1 due to bile duct injury and 1 due to bleeding from cystic artery stump). One patient had myocardial infarction and 3 had nausea and vomiting which failed to resolve by intravenous ondensteron and all these (13) patients (4.20%) needed unplanned admission to the hospital. Two hundred and ninety-six patients (95.79%) were discharged on same day. Conclusions In conclusion day care laparoscopic cholecystectomy is feasible, safe and equally effective in selected patients in Indian setup.
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Affiliation(s)
- Lileswar Kaman
- General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Javid Iqbal
- General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ishwar Bukhal
- General Anesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Dahiya
- General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajinder Singh
- General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Borowski D, Knox M, Kanakala V, Richardson S, Seymour K, Attwood S, Slater B. Referral pathways of patients with gallstones: a potential source of financial waste in the U.K. National Health Service? Int J Health Care Qual Assur 2011; 23:248-57. [PMID: 21388103 DOI: 10.1108/09526861011017139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Gallstone-related illnesses are one of the most common reasons for emergency hospital admissions, often with serious complications. Standard treatment of uncomplicated gallstone-disease is by laparoscopic cholecystectomy, which can be safely and cost-effectively performed during a short hospital stay or as day-case. This paper aims to evaluate the referral pattern of patients with gallstones, which treatment is given and whether patients admitted as emergency could have benefited from earlier elective referral. The management of these patients is examined in the context of payment by results to determine cost and potential savings. DESIGN/METHODOLOGY/APPROACH The approach takens was prospective clinical audit and patient questionnaire in a district general hospital. Cost comparisons were made using secondary care income (NHS tariff) and estimated cost of hospitalisation, investigations and treatment. FINDINGS Between May and July 2007, 114 patients were admitted with symptomatic gallstones, 62 (54.4 per cent) were emergencies. Cholecystectomy was performed in all 52 elective patients and performed or planned for 59/62 (95.2 per cent) emergencies. A total 17/62 emergencies (27.4 per cent) presented with complications of gallstones. 38/62 (61.3 per cent) had similar symptoms before, with 21/38 (55.3 per cent) diagnosed in primary care or by another hospital department. 11 (52.4 per cent) of these had not been referred for a surgical opinion; taking account of age, co-morbidity and data acquired for elective admissions, the cost of their treatment could have been reduced by at least pounds 16,194. ORIGINALITY/VALUE A large proportion of patients admitted with symptomatic biliary disease could have been referred earlier and electively. Such referral practice could improve the quality of care and reduce cost for the NHS both in primary and secondary care.
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Affiliation(s)
- David Borowski
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
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Abstract
BACKGROUND We report our experience at The Ottawa Hospital with outpatient laparoscopic adrenalectomy. METHODS We report a single surgeon experience. Seventeen consecutive outpatient laparoscopic adrenalectomy were performed between 1994 and 2006. Specific selection criteria were applied. Postoperatively patients were monitored and assessed before discharge. Full discharge instructions were provided. A prescription for analgesic was given. A call back system was put in place. The first postoperative office visit was scheduled within 7 days of surgery. RESULTS Twelve of 17 patients were females. The mean age was 52.4 years. Our average operating room time was 130 minutes with no conversions. The average stay was about 5.5 hours. Three patients had a 23-hour stay. One admitted with atelectasis. Tumor size ranged from 1 to 5.8 cm. There were no reoperations, late admissions up to 30 days, and no deaths. One patient required admission. Thirteen of 17 patients were contacted by phone after discharge. At our hospital we found a cost saving of C$1478 is made per case. CONCLUSIONS Laparoscopic adrenalectomy can be safely performed as an outpatient procedure. Strict selection criteria should be applied. Call back systems should be instituted. There is a cost benefit associated with this outpatient procedure.
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Abstract
BACKGROUND A severity grading system is essential to reporting surgical complications. In 1992, we presented such a system (T92). Its use and that of systems derived from it have increased exponentially. Our purpose was to determine how well T92 and its modifications have functioned as a severity grading system and to develop an improved system for reporting complications. METHODS 129 articles were studied in detail. Twenty variables were searched for in each article with particular emphasis on type of study, substitution of qualitative terms for grades, grade compression, and cut-points if grade compression was used. We also determined relative distribution of complications and manner of presentation of complications. RESULTS T92 and derivative classifications have received wide use in surgical studies ranging from small studies with few complications to large studies of complex operations that describe many complications. There is a strong tendency to contract classifications and to substitute terms with self evident meaning for the numerical grades. Complications are presented in a large variety of tabular forms some of which are much easier to follow than others. CONCLUSIONS Current methods for reporting the severity of complications incompletely fulfill the needs of authors of surgical studies. A new system-the Accordion Severity Grading System-is presented. The Accordion system can be used more readily for small as well as large studies. It introduces standard definition of simple quantitative terms and presents a standard tabular reporting system. This system should bring the field closer to a common severity grading method for surgical complications.
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Jain A, Davis PA, Ahrens P, Livingstone JI, Cahill CJ. Is day-case laparoscopic cholecystectomy acceptable to patients? A 5-year study. MINIM INVASIV THER 2009. [DOI: 10.3109/13645700009063040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chieh Kow AW, Tan A, Chan SP, Lee SF, Chan CY, Liau KH, Kiat Ho C. An audit of ambulatory laparoscopic cholecystectomy in a Singapore institution: are we ready for day-case laparoscopic cholecystectomy? HPB (Oxford) 2008; 10:433-8. [PMID: 19088930 PMCID: PMC2597325 DOI: 10.1080/13651820802392312] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND Day-Case laparoscopic cholecystectomy (LC) is practiced in many countries. However, this has yet to be widely accepted in Singapore. This study aims to determine the potential success rate of day-case LC in our institution. PATIENT AND METHODS We retrospectively assessed the proportion of our Ambulatory Surgery 23 hour (AS23) LC patients that met discharge criteria. Our proposed same-day discharge criteria include minimal pain, ability to tolerate feeds, ambulate independently and void spontaneously after 6-8 hours of monitoring. RESULTS From January 2005 to December 2006, of 405 patients listed for elective LC, 84% of patients were admitted to our AS23 ward. Patients with previous biliary sepsis or pancreatitis or who need laparoscopic common bile duct exploration (LCBDE) were included. The other 66 were admitted as inpatient. Forty-one of them were admitted due to conversion. A history of cholecystitis or cholangitis was a significant predictor of conversion to open surgery (OR=5.73 and 5.74 respectively, p<0.001). Of the 339 patients, 66% of them fulfilled all four criteria within eight hours of monitoring. Therefore, based on an intention-to-treat analysis, 51.2% fulfilled all four criteria and could potentially be discharged the same day. No predictor for failure was identified, including presence of co-morbidities, duration of operation, surgeon's grade and additional procedures like LCBDE. CONCLUSION Using our current inclusion criteria, we projected a success rate of at least 50% with the implementation of day-case LC. With the attendant advantages of cost savings and reduced resource utilization, it is therefore worthwhile to start it in Singapore.
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Affiliation(s)
- Alfred Wei Chieh Kow
- Department of General Surgery, Centre for Advanced Laparoscopic Surgery (CALS), Digestive Disease Centre, Tan Tock Seng HospitalSingapore
| | - Amanda Tan
- Department of General Surgery, Centre for Advanced Laparoscopic Surgery (CALS), Digestive Disease Centre, Tan Tock Seng HospitalSingapore
| | | | - Sow Fong Lee
- Day Surgery Centre, Tan Tock Seng HospitalTan Tock SengSingapore
| | - Chung Yip Chan
- Department of General Surgery, Centre for Advanced Laparoscopic Surgery (CALS), Digestive Disease Centre, Tan Tock Seng HospitalSingapore
| | - Kui Hin Liau
- Department of General Surgery, Centre for Advanced Laparoscopic Surgery (CALS), Digestive Disease Centre, Tan Tock Seng HospitalSingapore
| | - Choon Kiat Ho
- Department of General Surgery, Centre for Advanced Laparoscopic Surgery (CALS), Digestive Disease Centre, Tan Tock Seng HospitalSingapore
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Day-case laparoscopic Nissen fundoplication. Surg Endosc 2008; 23:1745-9. [DOI: 10.1007/s00464-008-0178-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Accepted: 07/31/2008] [Indexed: 01/10/2023]
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Quaynor H, Raeder JC. Incidence and severity of postoperative nausea and vomiting are similar after metoclopramide 20 mg and ondansetron 8 mg given by the end of laparoscopic cholecystectomies. Acta Anaesthesiol Scand 2008. [DOI: 10.1046/j.0001-5172.2001.00000_46_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kranke P, Redel A, Schuster F, Muellenbach R, Eberhart LH. Pharmacological interventions and concepts of fast-track perioperative medical care for enhanced recovery programs. Expert Opin Pharmacother 2008; 9:1541-64. [DOI: 10.1517/14656566.9.9.1541] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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35
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Wasowicz-Kemps DK, Slootmaker SM, Kemps HMC, Borel-Rinkes IHM, Biesma DH, van Ramshorst B. Resumption of daily physical activity after day-case laparoscopic cholecystectomy. Surg Endosc 2008; 23:2034-40. [PMID: 18437470 DOI: 10.1007/s00464-008-9928-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 02/24/2008] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy has been proven to be safe and feasible as a day-case procedure. Few studies investigated postoperative activity resumption. The goal of this study was to objectively assess daily physical activity after day-case laparoscopic cholecystectomy and evaluate the effect of encouragement of patients. METHODS This prospective controlled study measured daily physical activity in an unselected patient population undergoing day-case laparoscopic cholecystectomy by using an accelerometer for 1 week before surgery to 1 week after. First, a control group received standard care. Subsequently, an intervention group was encouraged to swift resumption of daily physical activity by means of standardized advice combined with individualized activity goals. Outcome measures were activity scores, visual analogue scores (VAS) for pain and nausea and subjective factors limiting activity. RESULTS Sixty-four patients completed the study (n = 28 in the control group, n = 36 in the intervention group). In the control group, 36% of the patients reached their preoperative activity level after 1 week, as compared to 50% in the intervention group (p = 0.19). Resumption of daily physical activity during the first postoperative week in the intervention group was not significantly different from the control group [repeated measures analysis of variance (MANOVA), p = 0.05]. However, in contrast with men, women in the intervention group did show a faster recovery of daily physical activity as compared to the control group (MANOVA, p = 0.02). Although there was no significant difference in postoperative VAS scores for pain and nausea between both groups, patients in the intervention group experienced pain less often as a limiting factor (p = 0.006). CONCLUSION Recovery of daily physical activity exceeded 1 week in most patients undergoing day-case laparoscopic cholecystectomy. The use of an accelerometer and standardized encouragement accelerated recovery in women.
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Affiliation(s)
- Daria K Wasowicz-Kemps
- Department of Surgery, St Antonius Hospital, Koekoekslaan 1, PO Box 2500, Nieuwegein, 3430 EM, The Netherlands.
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36
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A meta-analysis of ambulatory versus inpatient laparoscopic cholecystectomy. Surg Endosc 2008; 22:1928-34. [DOI: 10.1007/s00464-008-9867-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 12/26/2007] [Accepted: 01/18/2008] [Indexed: 10/22/2022]
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Vandenbroucke F, Létourneau R, Roy A, Dagenais M, Bellemare S, Plasse M, Lapointe R. Cholécystectomie coelioscopique ambulatoire : expérience d’un an sur des patients non sélectionnés. ACTA ACUST UNITED AC 2007; 144:215-8. [DOI: 10.1016/s0021-7697(07)89517-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tsang YY, Poon CM, Lee KW, Leong HT. Predictive factors of long hospital stay after laparoscopic cholecystectomy. Asian J Surg 2007; 30:23-8. [PMID: 17337367 DOI: 10.1016/s1015-9584(09)60123-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Laparoscopic cholecystectomy (LC) is the most common minimally invasive surgery in Hong Kong. However, ambulatory LC is not a common practice in Hong Kong. This study aims to identify the causes of long hospital stay after elective LC and to delineate a guideline for ambulatory LC. METHODS A retrospective analysis of 278 patients who underwent successful elective LC in a single unit between 1 January 2002 and 31 December 2003 was performed. They were divided into two groups: LS group had a long hospital stay (>24 hours after operation) and SS group had a short hospital stay. A total of 18 variables, including five patient variables, nine operative variables and four postoperative variables, were identified for univariate analysis. Significant pre- and postoperative factors were included in the multivariate analysis to identify independent predictive factors for long hospital stay. RESULTS Of the 278 patients, 118 (44.2%) could be discharged within 24 hours, while 149 (55.8%) had long hospital stay. Nine significant factors were identified in the univariate analysis; three independent factors were found to predict long hospital stay in the multivariate analysis. Patients with age more than 60 years had double risk of long hospital stay. Patients who could not tolerate diet within 8 hours or took more than two tablets of oral analgesia (dologesics) had a four- and threefold increase in risk of long hospital stay, respectively. CONCLUSION With careful patient selection, optimal postoperative pain control and early resumption of diet with better management of postoperative nausea and vomiting, ambulatory LC was feasible and safe.
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Affiliation(s)
- Yee-Yan Tsang
- Department of Surgery, North District Hospital, New Territories, Hong Kong SAR
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Topal B, Peeters G, Verbert A, Penninckx F. Outpatient laparoscopic cholecystectomy: clinical pathway implementation is efficient and cost effective and increases hospital bed capacity. Surg Endosc 2007; 21:1142-6. [PMID: 17237916 DOI: 10.1007/s00464-006-9083-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2006] [Revised: 03/12/2006] [Accepted: 05/12/2006] [Indexed: 01/18/2023]
Abstract
BACKGROUND Outpatient laparoscopic cholecystectomy (OLC) may decrease the use of hospital resources and save costs. In the current study, the effect of implementing a clinical pathway has been assessed in terms of outcome for patients scheduled to undergo laparoscopic cholecystectomy, hospital costs, and available bed capacity. METHODS Clinical outcome and hospital stay were analyzed for consecutive patients scheduled to undergo laparoscopic cholecystectomy 1 year before (n = 338) and after (n = 336) implementation of a clinical pathway. Patients with acute cholecystitis or bile duct lithiasis were excluded from the study. A cost accounting model was developed using the concept of the bill of activities. RESULTS Before implementation of the clinical pathway, 34 (94%) of 36 patients scheduled for OLC were discharged successfully on the day of surgery, as compared with 110 (94%) of 117 patients after pathway implementation. Among patients scheduled for OLC, the complication (0% vs 1.7%), unplanned admission (5.5% vs 6%), and readmission (0% vs 4.3%) rates were comparable before and after clinical pathway implementation. After pathway implementation, the increased number of OLCs resulted in a significant cost saving (40.5%) and benefit in bed capacity (1.41 beds per day per year) for the hospital. CONCLUSION The implementation of a clinical pathway preserves the clinical outcome for patients undergoing OLC. It creates a significant increase in the number of patients treated in an outpatient setting and confers a significant benefit in terms of hospital costs and available bed capacity.
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Affiliation(s)
- B Topal
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Herestraat 49, Leuven, Belgium.
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40
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Chauhan A, Mehrotra M, Bhatia PK, Baj B, Gupta AK. Day care laparoscopic cholecystectomy: a feasibility study in a public health service hospital in a developing country. World J Surg 2006; 30:1690-5; discussion 1696-7. [PMID: 16902738 DOI: 10.1007/s00268-006-0023-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Day care laparoscopic cholecystectomy (DCLC) has been shown to be safe in centers with adequate infrastructure for day care surgery in economically advanced countries. However, the feasibility of applying this concept in public health service hospitals in less developed and developing nation needs to studied. Unique protocols need to be developed and tested, taking into account local conditions and infrastructural constraints. PATIENTS AND METHODS Patients less than 60 years old, graded I and II on the American Society of Anesthesiologists (ASA) physical status score, living within one hour traveling time and willing to make their own arrangements for a return to hospital in case of problems, were selected for DCLC. RESULTS 291 cases (78%) out of 373 laparoscopic cholecystectomies done in one calendar year were found suitable for DCLC. The most common cause for omitting from DCLC was that the patient lived out of the defined area (57%). Four of 291 (1.3%) cases were cancelled due to medical condition; 270/287 (96.1%) were discharged the same evening as surgery; 6 patients were converted to open surgery; and 11 did not meet the necessary discharge criteria. Eight of 270 (2.9%) required readmission out of which 3 (1.1%) required intervention. Overall, incidence of complication rate was 3.4%. Analysis of data showed that results were comparable to previously published studies, hence extrapolating that inclusion and discharge criteria used in the study are valid. However, there are certain social constraints which hinder truly universal application of DCLC. CONCLUSIONS DCLC is a safe and technically feasible concept, even in public health service centers without dedicated ambulatory surgery units. It has potential for much economical and social benefit in these countries.
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Affiliation(s)
- A Chauhan
- Department of Surgery, Base Hospital, Delhi Cantt, Delhi 110010, India.
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41
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Victorzon M, Tolonen P, Vuorialho T. Day-case laparoscopic cholecystectomy: treatment of choice for selected patients? Surg Endosc 2006; 21:70-3. [PMID: 17001441 DOI: 10.1007/s00464-005-0787-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Accepted: 04/02/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The authors report their 7-year experience with day-case laparoscopic cholecystectomy (LC) to determine its applicability, safety, and cost effectiveness. METHODS Of 920 consecutive patients who underwent elective LC over a 7-year period, 567 (62%) were scheduled for day-case surgery. The median age of the patients was 48 years (range, 16-74 years), and the male/female ratio was 148/419. The selection criteria required an American Society of Anesthesiologists (ASA) grade of 1 or 2, absence of morbid obesity, low risk of common bile duct stones, adult company at home, and residence within 100 km of the hospital. The LC procedure was performed using a standard four-cannula technique. Propofol-opiate-rocuron-sevoflurane anesthesia, prophylactic antiemetics, and preemptive analgesia were administered in all cases. RESULTS The mean length of the operation was 56 +/- 18 min. There was no hospital mortality, and 7 (1.2%) of 567 patients required conversion to open cholecystectomy. Approximately 356 (63%) of the 567 patients were discharged home on the same day as the operation, whereas 211 patients (37%) were admitted overnight after the operation because of social reasons (13.7%), surgeon preference (15.2%), nausea and/or pain (15.2%), operation late in the afternoon (14.2%), or patient preference (41.7%). There were no serious complications. A total of 22 patients visited the emergency unit, and 7 patients required readmission, giving a readmission rate of 2%. The overall postoperative morbidity rate was 6% (n = 22), with morbidities including retained stones (n = 2), bile leakage (n = 1), and pneumonia (n = 1). The mean procedural cost to the hospital was 1,836 euros for day-case LC, as compared with 2,712 euros for an inpatient operation. CONCLUSIONS For selected patients, day-case LC is feasible and safe, providing a substantial reduction in hospital costs.
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Affiliation(s)
- M Victorzon
- Department of Gastrointestinal Surgery, Vaasa Central Hospital, Hietalahdenkatu 2-4, 65130, Vaasa, Finland.
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42
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Soria-Aledo V, Pellicer E, Candel-Arenas MF, Flores-Pastor B, Carrasco-Prats M, Miguel-Perelló J, Campillo A, Aguayo-Albasini JL. [Evaluation of a clinical pathway for laparoscopic cholecystectomy]. Cir Esp 2006; 77:86-90. [PMID: 16420893 DOI: 10.1016/s0009-739x(05)70813-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Clinical pathways are standardized plans for the integral care of specific processes. In March 2002, a clinical pathway for laparoscopic cholecystectomy was introduced in our service. The aim of the present study was to evaluate this pathway 1 year after its implementation. METHODOLOGY All patients included in the clinical pathway since its introduction were studied. Evaluation criteria included compliance, indicators of the effectiveness of clinical care, economic impact and indicators of satisfaction based on a survey. The results were compared with those in a series of patients who underwent surgery in the year before the introduction of the clinical pathway. Our hospital uses analytical accounting and the mean cost per process before and after the introduction of the clinical pathway was analyzed. RESULTS A series of 160 consecutive patients who underwent surgery during the year prior to the creation of the clinical pathway and who fulfilled the accepted inclusion criteria was evaluated. The mean length of hospital stay was 3.27 days. The mean cost per process before the introduction of the pathway was 2149 (+/- 768) euros. During the first year after the introduction of the pathway, 140 patients were included with an inclusion rate of 100%. The mean length of hospital stay in patients included in the clinical pathway was 2.2 days. The degree of compliance with length of hospital stay was 66.7%. The most frequent causes of breach were staff-related, followed by patient-related (oral intolerance, pain, etc.). The mean cost in patients included in the clinical pathway was 1845 (+/- 618) euros. CONCLUSIONS Laparoscopic cholecystectomy is a suitable process with which to initiate systematization of clinical pathways. The results show that length of hospital stay has been significantly reduced without increasing morbidity. Patient satisfaction has been high.
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Affiliation(s)
- Víctor Soria-Aledo
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario J.M. Morales Meseguer, Murcia, España.
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Johansson M, Thune A, Nelvin L, Lundell L. Randomized clinical trial of day-care versus overnight-stay laparoscopic cholecystectomy. Br J Surg 2006; 93:40-5. [PMID: 16329083 DOI: 10.1002/bjs.5241] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy has been performed as a day-care procedure for many years. Few studies have been conducted with primary focus on patient acceptance and preferences in terms of quality of life for this practice compared with overnight stay. METHODS Data from 100 patients with symptomatic gallstones randomized to laparoscopic cholecystectomy performed either as a day-care procedure or with overnight stay were analysed. Complications, admissions and readmissions, quality of life and health economic aspects were assessed. Two instruments were used to assess quality of life, the Hospital Anxiety and Depression Scale (HADS) and the Psychological General Well-Being Index (PGWB). RESULTS Forty-eight (92 per cent) of 52 patients in day-care group were discharged 4-8 h after the operation. Forty-two (88 per cent) of 48 in the overnight group went home on the first day after surgery. The overall conversion rate was 2 per cent. Two patients had complications after surgery, both in the day-care group. No patient in either group was readmitted. There was no significant difference in total quality of life score between the two groups. The mean direct medical cost per patient in the day-care group (3085 Euros) was lower than that in the overnight group (3394 Euros). CONCLUSION Laparoscopic cholecystectomy can be performed as a day-case procedure with a low rate of complications and admissions/readmissions. Patient acceptance in terms of quality of life variables is similar to that for cholecystectomy with an overnight stay. The day-care strategy is associated with a reduction in cost.
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Affiliation(s)
- M Johansson
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Jain PK, Hayden JD, Sedman PC, Royston CMS, O'Boyle CJ. A prospective study of ambulatory laparoscopic cholecystectomy: training economic, and patient benefits. Surg Endosc 2005; 19:1082-5. [PMID: 16021378 DOI: 10.1007/s00464-004-2170-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Accepted: 01/15/2005] [Indexed: 12/13/2022]
Abstract
BACKGROUND Even though ambulatory laparoscopic cholecystectomy (ALC) is safe and cost effective, this approach has yet to gain acceptance in the United Kingdom. We report our 5-year experience of ALC with emphasis on its appropriateness for higher surgical training. METHODS Between July 1997 and July 2002, patients with symptomatic cholelithiasis who met with appropriate criteria underwent ALC. Surgery was performed either by a consultant surgeon or a higher surgical trainee (HST) under direct supervision in our dedicated day surgery unit. Data were recorded prospectively and patients were interviewed postoperatively by an independent researcher. RESULTS There were 269 patients (231 female and 38 male) with a median age of 46 years (range 17-76). Conversion to open cholecystectomy was necessary in three cases (1%). Of the patients, 79% (213) were discharged within 8 hours of surgery; 95% (256) were discharged on the same day. Thirteen patients (5%) required overnight admission as inpatients. An HST performed 166 (62%) of the procedures. There was a statistically significant difference in operating time between consultants (41 min) and trainees (47 min, P = 0.001) but no significant difference in clinical outcome or patient satisfaction. The mean procedural cost to the hospital was 768 pound sterling for ALC compared with 1430 pound sterling for an inpatient operation. Of patients, 87% expressed satisfaction with the day case operation. CONCLUSION Our results for ALC compare favorably with published series. In addition, we have demonstrated that the operation can be performed safely by HST under direct supervision without compromising operating lists or safety.
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Affiliation(s)
- P K Jain
- Division of Upper Gastrointestinal and Minimally Invasive Surgery, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, United Kingdom
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Soria VÍ, Pellicer E, Flores B, Carrasco M, Fe Candel M, Aguayo JL. Evaluation of the Clinical Pathway for Laparoscopic Cholecystectomy. Am Surg 2005. [DOI: 10.1177/000313480507100107] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Clinical pathways are comprehensive systematized patient care plans for specific procedures. The clinical pathway for laparoscopic cholecystectomy was implemented in our department in March 2002. The aim of this study is to evaluate the clinical pathway for this procedure 1 year after implementation. A study was conducted on all the patients included in the clinical pathway since its implementation. The assessment criteria include degree of compliance, indicators of clinical care effectiveness, financial impact, and survey-based indicators of satisfaction. The results are compared to a series of patients undergoing surgery the year prior to implementation of the clinical pathway. As our hospital has a system of cost management, we analyzed the mean cost per procedure before and after clinical pathway implementation. Evaluation was made of a series of 160 consecutive patients who underwent surgery during the period 1 year prior to development of the clinical pathway and met the accepted inclusion criteria. The mean length of hospital stay was 3.27 days, and the mean cost per procedure before pathway implementation was 2149 (±768) euros. One year after implementation of the pathway, 140 patients were included (i.e., an inclusion rate of 100%). The mean length of hospital stay of the patients included in the clinical pathway was 2.2 days. The degree of compliance with stays was 66.7 per cent. The most frequent reasons for noncompliance were staff-dependent, followed by patient-dependent causes (oral intolerance, pain, etc.). The mean cost in the series of patients included in the clinical pathway was 1845 (± 618) euros. Laparoscopic cholecystectomy is an ideal procedure for commencing the systemization of clinical pathways. Results show that it has significantly reduced the length of hospital stay and mean cost per procedure with no increased morbidity and with a high degree of patient satisfaction.
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Affiliation(s)
- VÍctor Soria
- Departamento de Cirugía General, Hospital J.M. Morales Meseguer, 30008 Murcia, Spain
| | - Enrique Pellicer
- Departamento de Cirugía General, Hospital J.M. Morales Meseguer, 30008 Murcia, Spain
| | - Benito Flores
- Departamento de Cirugía General, Hospital J.M. Morales Meseguer, 30008 Murcia, Spain
| | - Milagros Carrasco
- Departamento de Cirugía General, Hospital J.M. Morales Meseguer, 30008 Murcia, Spain
| | - Maria Fe Candel
- Departamento de Cirugía General, Hospital J.M. Morales Meseguer, 30008 Murcia, Spain
| | - Jose Luis Aguayo
- Departamento de Cirugía General, Hospital J.M. Morales Meseguer, 30008 Murcia, Spain
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Vuilleumier H, Halkic N. Laparoscopic Cholecystectomy as a Day Surgery Procedure: Implementation and Audit of 136 Consecutive Cases in a University Hospital. World J Surg 2004; 28:737-40. [PMID: 15457349 DOI: 10.1007/s00268-004-7376-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Laparoscopic cholecystectomy (LC) has been routinely performed since 1989 at our institution, and patients were traditionally admitted for 2 days. In 1996 we implemented a protocol for LC as a day surgery procedure at our center. Although initially reported by others, it has not yet been introduced as routine in Switzerland. The objective of this prospective study was to determine acceptability and safety of LC as an outpatient procedure in a university hospital. Data were collected prospectively for 136 LCs between January 1996 and December 2001. Patients were selected for the study if they wanted to go home within less than 24 hours, had no previous jaundice, and had no anesthetic contraindication. Systematic preoperative liver function tests and hepatic ultrasonography were performed. All patients were admitted on the day of operation. LC was performed using a three-trocar technique. Systematic cholangiography was performed, and all the procedures were completed laparoscopically. There were no common bile duct explorations. Postoperative complications were the following: nausea in seven patients, a minor umbilical hematoma in two. According to patient preference, 101 (74%) were discharged after an overnight stay (less than 24 hours) and 32 (24%) on the same day. The unplanned admission rate was 2%, and none of the patients was subsequently readmitted. The reasons for unplanned admissions were two patients with persistent nausea and one patient for whom an overnight stay was scheduled who presented with a ruptured subcapsular hematoma of the liver. Altogether, 97% of the patients were satisfied with the care they received. Operative costs were not significantly different when comparing inpatient and outpatient LC. The main postoperative savings were in the postoperative costs. Our results confirm that LC as a day surgery procedure is safe, effective, and acceptable to patients and their relatives. These results were achieved by using selection criteria that considered not only the surgical pathology but also the individual and by using appropriate techniques and planned postoperative analgesia.
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Affiliation(s)
- Henri Vuilleumier
- Department of Surgery, University Hospital, 1011, Lausanne-CHUV, Switzerland.
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Edwin B, Skattum X, Rãder J, Trondsen E, Buanes T. Outpatient laparoscopic splenectomy: patient safety and satisfaction. Surg Endosc 2004; 18:1331-4. [PMID: 15803231 DOI: 10.1007/s00464-003-9174-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2003] [Accepted: 01/10/2004] [Indexed: 02/08/2023]
Abstract
BACKGROUND We assessed the feasibility of outpatient laparoscopic splenectomy, as performed by an experienced laparoscopic term and combined with optimal anesthesia. METHODS Inclusion criteria in the study was limited to patients not hospitalized before the procedure who had hematological or neoplastic indications for splenectomy and were classified as American Society of Anesthesiologists (ASA) I-III. They received general intravenous anesthesia with propofol and remifentanil and were given keterolac, propacetamol, droperidol, and ondansetron as prophylaxis against postoperative pain and nausea. Laparoscopic splenectomy was performed via three trocars. The specimen was removed via an incision in the left iliac fossa. RESULTS Ten of the 12 patients were discharged 3-6 h postoperatively; the other two were admitted primarily to hospital. One was readmitted due to a fever, which was finally explained by measles. The median operative times was 58 min (range, 45-135). Patient satisfaction was excellent in nine and intermediate in two cases; it was poor in one case, due to postoperative pain. CONCLUSION Laparoscopic splenectomy can be completed in a relatively short time; therefore, it is feasible, safe, and satisfactory for most patients as an outpatient procedure.
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Affiliation(s)
- B Edwin
- Interventional Center, National Hospital, 0407, Oslo, Norway
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Syrakos T, Antonitsis P, Zacharakis E, Takis A, Manousari A, Bakogiannis K, Efthimiopoulos G, Achoulias I, Trikoupi A, Kiskinis D. Small-incision (mini-laparotomy) versus laparoscopic cholecystectomy: a retrospective study in a university hospital. Langenbecks Arch Surg 2004; 389:172-7. [PMID: 15133673 DOI: 10.1007/s00423-004-0481-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2003] [Accepted: 03/10/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Since the introduction of laparoscopic cholecystectomy into general practice in 1990, it has rapidly become the dominant procedure for gallbladder surgery. The aim of this study was to compare the results of the laparoscopic, open and mini-laparotomy approaches to cholecystectomy. PATIENTS AND METHODS Our study covers a period of 6 years. A total of 1,276 patients underwent cholecystectomy for calculous biliary disease. The laparoscopic procedure was applied to 952 (74.6%) patients, while 210 (16.5%) underwent the traditional open cholecystectomy and the remaining 114 (8.9%) patients underwent mini-laparotomy cholecystectomy. RESULTS Thirty-seven patients (3.9%) from the laparoscopic group required conversion to open cholecystectomy. Morbidity was similar in the open and laparoscopic groups (3.8%), while it was significantly lower in the mini-laparotomy group (0.8%). No major bile duct injuries occurred after the open or mini-laparotomy approaches. The median operation time was significantly shorter in the mini-laparotomy group than in the laparoscopic group (46 min vs 61 min). Hospital stay was significantly longer for the open cholecystectomy group (mean value 5.1 days) compared with the laparoscopic and mini-laparotomy groups (mean values 2.5 days and 2.7 days, respectively). Hospital expenses showed a saving of 786 Euro for each patient who underwent the open procedure and 980 Euro for each patient who underwent the mini-laparotomy approach compared with the laparoscopic one. CONCLUSION We believe that commissioners of healthcare should question whether the benefits of laparoscopic cholecystectomy justify the additional cost after the introduction of the mini-laparotomy approach.
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Affiliation(s)
- Theodoros Syrakos
- A' Surgical Clinic, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Leeder PC, Matthews T, Krzeminska K, Dehn TCB. Routine day-case laparoscopic cholecystectomy. Br J Surg 2004; 91:312-6. [PMID: 14991631 DOI: 10.1002/bjs.4409] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND A prospective study was carried out to assess the feasibility of performing true day-case laparoscopic surgery in a district general hospital. METHODS All patients admitted consecutively under the care of one surgeon for laparoscopic cholecystectomy were included in the study. Selection criteria for a day-case procedure included an American Society of Anesthesiologists grade of I or II and the availability of a responsible carer at home. Patients were discharged 4-6 h after surgery with a standard analgesia pack and a contact number for advice. All patients were contacted by telephone on the day after discharge. A postal questionnaire was sent to the first 100 patients to assess satisfaction with the day-case process. RESULTS Of 357 patients admitted for laparoscopic cholecystectomy over a 24-month period, 154 (43.1 per cent) were operated on as day cases on a morning theatre list. Twenty-two patients required an overnight stay (14.3 per cent), three because of conversion to an open procedure. One patient was readmitted for neck pain. Eighty-two (92.1 per cent) of 89 patients were either satisfied or very satisfied with the day-case procedure. CONCLUSION This study has demonstrated a low rate of overnight stay (14.3 per cent) and readmission (1.9 per cent), and a high degree of patient satisfaction for day-case laparoscopic cholecystectomy.
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Affiliation(s)
- P C Leeder
- Department of Surgery, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK
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Bal S, Reddy LGS, Parshad R, Guleria R, Kashyap L. Feasibility and safety of day care laparoscopic cholecystectomy in a developing country. Postgrad Med J 2003; 79:284-8. [PMID: 12782776 PMCID: PMC1742692 DOI: 10.1136/pmj.79.931.284] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although day care laparoscopic cholecystectomy (DCLC) has been shown to be safe in centres with adequate infrastructure for day care surgery, its feasibility and safety in developing countries has never been studied. Because of differences in the quality of health care delivery, western guidelines for day care surgery cannot be universally applied to developing countries. PATIENTS AND METHODS Patients less than 65 years who were graded I and II on the American Society of Anesthesiologists physical status score, irrespective of their educational status, living within 20 km, and willing to make their own arrangements for a return to hospital in case of problems were selected for DCLC. Follow up was done by patients calling the hospital the morning after surgery. RESULTS 50% of the eligibility criteria were new; 313/383 patients were suitable for DCLC. The commonest cause for rejection was that the patient lived out of the defined area (50%). Altogether 92% were discharged within eight hours of surgery. The reasons for failure to discharge were the presence of abdominal drains in four (2%), nausea and vomiting in nine (3%), and conversion to open surgery in five (2%). Ten patients (3%) were readmitted; of these only two (<1%) had complications needing re-exploration. Analysis of results showed that the inclusion and discharge criteria were valid and that the readmission and complication rates as well as the ease and accuracy of follow up were comparable to published data. DCLC reduced waiting times and increased patient turnover and may have a positive impact on resident training. CONCLUSIONS DCLC is safe, feasible, and has potential benefits for health care delivery in developing countries. Each surgical service needs to develop their own guidelines based on local patient demography.
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Affiliation(s)
- S Bal
- All India Institute of Medical Sciences, New Delhi, India.
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