Is outpatient laparoscopic cholecystectomy safe and cost-effective? A model to study transition of care.
BACKGROUND
There is increasing pressure to perform traditional inpatient surgical procedures in an outpatient setting. The aim of the current trial was to determine the safety and cost savings of performing laparoscopic cholecystectomy in an outpatient setting using a "mock" outpatient setting.


METHODS
Patients who were scheduled for laparoscopic cholecystectomy by four attending surgeons and for whom operating time was available in the outpatient center were studied. All patients received a standardized anesthetic, including ondansetron, and were discharged from the outpatient postanesthesia care unit if appropriate. At discharge, all patients were admitted to a clinical research center where they were observed in a "mock home" setting and monitored for complications that would have necessitated readmission. A decision analysis was created assuming all patients underwent outpatient surgery with either direct admission or discharge to home and readmission if complications developed.


RESULTS
Of 99 patients who were enrolled in this study, 96 patients would have met the discharge criteria for home. No major complications were observed in these 96 patients. Eleven patients experienced postoperative nausea and vomiting, 3 of whom required an additional 24 h of hospital observation. In the decision model, the optimal strategy would be to perform the procedure on an outpatient basis and readmit patients only for complications, with an average baseline cost savings of $742/patient.


CONCLUSIONS
The results show that outpatient laparoscopic cholecystectomy is safe and cost-effective in selected patients, and that the mock home setting provides a means of studying the safety of transition of care.
Fleisher
L A
LA
Department of Anesthesiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. lfleishe@welchlink.welch.jhu.edu
Yee
K
K
Lillemoe
K D
KD
Talamini
M A
MA
Yeo
C J
CJ
Heath
R
R
Bass
E
E
Snyder
D S
DS
Parker
S D
SD
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000191:economics; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D014839:Vomiting / Q000209:etiology