Am Fam Physician. 2003;68(2):365
Laparoscopic cholecystectomy (LC) is the optimal treatment for symptomatic gallstone disease. Same-day discharge following LC is associated with fewer complications and increased patient satisfaction, as well as savings in health care costs. However, inappropriately early discharge can place patients at risk and result in unplanned admissions. Robinson and colleagues sought to identify patients in whom same-day surgery can be planned with minimal risk of complications.
The investigators studied 387 consecutive patients scheduled for elective LC at an urban medical center. Patients with preoperatively recognized complications were excluded from the study. More than 90 percent of the patients were women; the average age was 35 years. All study participants underwent LC by a standardized technique that was successfully completed in 269 cases (70 percent).
A total of 118 patients (30 percent) required hospital admission. The principal reason for admission in 30 cases was a clinical decision by the surgeon. Twenty-six admissions were because of conversion to open cholecystectomy, 17 for oxygen requirement, 11 for nausea/vomiting, and 10 for pain control. The time of surgery was implicated in 24 hospital admissions. Univariate analysis identified only four variables associated with failure of same-day discharge following LC surgery. These factors were patient age older than 50 years, anesthesia risk (American Society of Anesthesiologists [ASA] class 3), surgery starting later than 1 p.m., and duration of surgery. The average duration of surgery for those admitted was 108 minutes, compared with 78 for same-day discharge patients (see accompanying table). Body mass index, white blood cell count, liver function tests, gall bladder wall thickness, and the presence of pericholecystic fluid did not predict admission.
The authors conclude that patients older than 50 years, those with ASA scores of 3 or more, and those whose surgeries begin after 1 p.m. have a greater than 50 percent chance of admission following LC. These factors should be taken into consideration when planning same-day discharge and in making treatment decisions for individual patients.
|Age||33 0.7 years||44 1.3 years||< .05|
|ASA classification||1.8 0.03||2.1 0.05||< .05|
|Procedure length||78 2 minutes||108 5 minutes||< .05|
|Start time||9:48 a.m. 7 minutes||11:38 a.m. 18 minutes||< .05|