Leen Nesnas
Introduction
Early laparoscopic cholecystectomy is the known gold standard for treatment of gallstone pathology. These patients can be scheduled for surgery via a day case pathway. The British Association of Day Surgery (BADS) Directory of Procedures sets a target day case rate of 75% for laparoscopic cholecystectomy. The aim of this audit was to assess the rate of our day case lap cholecystectomies and associated factors that could be prevented.
Method
This study was done in form of clinical audit retrospectively collecting data for 6 months in a district general hospital. Collection of data included all elective laparoscopic cholecystectomies.
Results
181 patients underwent an elective LC during this period. 32 of these patients were overnight stays, of which 24 were unplanned overnight stays (UOS) , which was 13.26% of all patients. Of these UOS patients, most common reasons included intraoperative complications requiring drain insertion (58.3% of UOS), post-operative pain, and social reasons. Most patients with BMI >35 and ASA3 planned day case patients were successfully discharged. There was a total of 26 (14.36%) of 30-day readmissions.
Conclusion
Our hospital does have a rate of 82% day case laparoscopic cholecystectomies. Patient factors such as high BMI and ASA3 should not be absolute contraindications. Although many unexpected overnight stays are unavoidable, some can be prevented by addressing modifiable factors—such as avoiding routine overnight admission for drain insertion, or improving the management of postoperative pain through timely and appropriate discharge medications.
Authors
Leen Nesnas
North Devon District Hospital NHS, Barnstaple, United Kingdom
Sourabh Dhar
North Devon District Hospital NHS, Barnstaple, United Kingdom
Aleksandra Li
Nottingham University Hospital, Nottingham, United Kingdom