[Ambulatory laparoscopic cholecystectomy is as effective as hospitalization and from a social perspective less expensive: a randomized study].
OBJECTIVE
To compare the effects and costs of an ambulatory treatment versus an overnight stay for laparoscopic cholecystectomy.


METHODS
Prospective, randomised.


METHODS
In the St Antonius hospital, Nieuwegein, the Netherlands, 86 patients with symptomatic cholelithiasis without comorbidity underwent either ambulatory (AM: 42 patients: 8 men and 36 women; mean age: 48.9 years (SD: 11.9)) or overnight stay (OS: 44 patients: 10 men and 32 women; mean age: 44.9 years (SD: 11.8)) laparoscopic cholecystectomy in the period 1 November 1997-30 September 1999. The following were registered: operative time, complications, hospital stay and readmissions, as well as reported pain, nausea, activity resumption, quality of life and patient satisfaction. The cost analysis was performed from a societal and hospital perspective.


RESULTS
In the OS group one laparoscopic procedure was converted to open cholecystectomy, two relaparotomies were performed due to intra-abdominal haemorrhage and 1 patient had a catheter inserted due to urine retention. Two patients were readmitted, one for postoperative pancreatitis and the other for a retained bile duct stone. In the AM group one laparoscopic procedure was converted to open cholecystectomy, in 1 patient a wound abscess was treated with drainage in the outpatient clinic, in 1 patient there was peroperative stone loss without further complications and in 1 patient a catheter was placed to drain peroperative bile and blood loss. In the AM group 11 (26%) patients were kept overnight due to nausea and/or pain (n = 7) or one of the aforementioned complications (n = 4). Two patients were readmitted within 24 hours of being discharged due to abdominal pain. The average hospital stay was 3.1 (OS) versus 1.7 (AM) days. The quality of life, pain, nausea and activity resumption were comparable for both groups. Due to the difference in hospital stay, costs for the ambulatory procedure were lower.


CONCLUSIONS
Laparoscopic cholecystectomy was successfully performed as an ambulatory surgery procedure in 69% of the patients. The quality of life, patient satisfaction and resumption of activities in both groups were comparable. The ambulatory treatment was less expensive.
Dirksen
C D
CD
Academisch Ziekenhuis, afd. Klinische Epidemiologie en Medical Technology Assessment, Postbus 5800, 6202 AZ Maastricht. cdir@aozg.azm.nl
Schmitz
R F
RF
Hans
K M
KM
Nieman
F H
FH
Hoogenboom
L J
LJ
Go
P M
PM
D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000191:economics* / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D011788:Quality of Life; D012086:Reoperation
Laparoscopische cholecystectomie in dagbehandeling even effectief als tijdens klinische opname en vanuit maatschappelijk perspectief goedkoper; een gerandomiseerd onderzoek.