101Smart Ltd.

Review of the factors leading to an unplanned inpatient stay following a day case Laparoscopic Cholecystectomy in a Tertiary centre

Anoop Rao, Mihir Rao, Bishow Karki, Ciara Doyle, Adam Barlow
St James's University Hospital, Leeds, United Kingdom


Introduction: Unplanned inpatient stay (IPS) following day case Laparoscopic Cholecystectomy (LC) has major implications for patients and healthcare systems. Aims: To review factors responsible for unplanned IPS, and develop strategies to prevent such unnecessary stays.

Methods: We retrospectively collected data on all LC performed in a Tertiary Centre over January – March 2022

Results: 162 patients underwent LC during this period; 132 (81.5%) patients were planned day cases out of whom 65/132 (49.2%) were reported IPS and 67/132 (50.8%) were documented same-day discharges (SDD).
Reasons identified in clinical notes for unplanned IPS: surgical team requests (e.g. operation note, criteria-led discharge; n=36), late patient recovery (n=23), drain insertion (n=9), social issues (n=5). n=14 had no documented IP causes identified. n=5 erroneously reported as IPS despite having SDD. Furthermore, n=34 IPS were performed in the afternoon compared to n=11 among SDD [p<0.0001]; n=3 afternoon cases found in which limited communication between nursing and surgical teams may have delayed discharge. Mean operation time was 92 min IPS vs 82 min SDD [adjusted OR 0.989]. Average ASA score was 2.2 for IPS compared to 1.9 for SDD [p=0.001].

Conclusions: The rate of unplanned overnight stay was significantly high (45.5%, 60/132). Several human factors such as errors in the booking list, late-afternoon cases, and no clear discharge planning in the post-op notes were among the few factors which could easily be improved. A review of these factors is deemed necessary not only for improving patient outcomes & quality of care but equally for reducing healthcare costs.