Establishing outpatient cholecystectomy as a hospital routine.
OBJECTIVE
To determine the rate of outpatient cholecystectomies done voluntarily by surgeons and to identify any "correctable" factors leading to hospital admission, also to reassess the outpatient cholecystectomy rate after correcting the identified factors.


METHODS
A prospective analysis.


METHODS
A 256-bed non-teaching acute-care community hospital on the outskirts of a major urban centre, served by 4 general surgeons.


METHODS
All 515 patients booked for elective cholecystectomy at the hospital between Apr. 1, 1994, and Mar. 31, 1996, inclusive.


METHODS
Elective outpatient cholecystectomy.


METHODS
A successful procedure without compromise of safety.


RESULTS
In the preliminary study, outpatient cholecystectomy was done in 75% of the patients. Variations in individual surgical practice, preoperative patient selection and inappropriate day surgery facilities were thought to be correctable factors leading to admission. After correction of the these factors (follow-up study), the rate of outpatient cholecystectomy rose to 95% (p < 0.001). Variations in individual surgical practice disappeared, and no patient required processing through inappropriate day surgery facilities. No patient suffered untoward effects from outpatient management.


CONCLUSIONS
Outpatient cholecystectomy is a safe hospital routine for all elective procedures without selection. Voluntary acceptance of this routine leads to an initial 75% outpatient rate. Identifying and correcting modifiable factors led to a significant increase in the institutional outpatient rate, comparable to reported individual rates.
Voitk
A J
AJ
Department of Surgery, Salvation Army Scarborough Grace Hospital, Ont.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D018579:Patient Selection; D011183:Postoperative Complications; D011446:Prospective Studies