Alexander Churton
Introduction
Our aim is achieving British Association of Day Surgery rates of 75% for laparoscopic cholecystectomy. This study identified perioperative factors which may influence day surgery success.
Methods
A retrospective review of 90 patients listed for day case laparoscopic cholecystectomy was conducted. Data were extracted from paper records and analysed in Microsoft Excel. Variables included patient characteristics, anaesthetic and surgical details, medications, recovery parameters, and discharge metrics. Patients were grouped by outcome: day case versus inpatient admission.
Results
Factors associated with day case completion included consultant anaesthetist involvement and administration of intraoperative paracetamol, non-steroidal anti-inflammatory drugs, dexamethasone, ondansetron, and magnesium (at lower doses). Post-anaesthesia care unit (PACU) antiemetic use and higher-dose intravenous lidocaine (used infrequently) were also more common in this group.
Inpatient admission was associated with higher intraoperative morphine doses; intravenous lidocaine (more frequently used at both induction and maintenance); longer surgical duration; greater intraoperative fluid volumes; extended PACU stay; and postoperative ward administration of analgesia and antiemetics. Subcutaneous morphine, oral codeine, and intravenous pethidine were also more frequently used in this group.
Local anaesthetic infiltration was common across both groups and not predictive of outcome.
Conclusions
Consultant involvement, specific medication administration, and shorter surgical duration were associated with day case success. These findings may inform perioperative strategies to reduce unplanned admissions.
Authors
Alexander Churton
Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
Samuel Haynes
Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
Benedict Jong
Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
Rachel Tibble
Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom