title: The learning curve in ambulatory laparoscopic cholecystectomy.
abstract: Whether laparoscopic cholecystectomy (LC) should be performed as an outpatient procedure is still under discussion. The aim of this study was to evaluate the influence of surgeon's experience in ambulatory management of LC. Three hundred eighty-one consecutive elective LCs were planned as outpatient procedures. An anesthetic protocol that includes free-opiates anesthesia, preemptive analgesia, and somatovisceral blockade was used. Percentages of ambulatory, overnight, and admitted patients were evaluated, and time series variation was also analyzed. Postoperative pain, nausea and vomiting incidence, postoperative recovery, and complications were examined. Two hundred ninety-one patients were strictly ambulatory (76.3%), 71 (18.6%) required overnight admission, and 19 (4.9%) were admitted. Percentage of ambulatory LC increased from 22% to 90% in 4 years of experience. Readmission rate was 0.01%. Free-opiates anesthetic techniques, preemptive analgesia, and somatovisceral blockade allowed us to obtain over 90% of ambulatory LC. The learning curve related to postoperative evaluation is crucial in obtaining those results.
authors.affiliation: Instituto de Cirugía General y del Aparato Digestivo, Clinica Quiron, Valencia, Spain.
authors.forename: Alfonso Serralta
authors.initials: AS
authors.lastname: Serra
authors.forename: Manuel Planells
authors.initials: MP
authors.lastname: Roig
authors.forename: Jose Bueno
authors.initials: JB
authors.lastname: Lledo
authors.forename: Angel Sanahuja
authors.initials: AS
authors.lastname: Santafe
authors.forename: Rafael Garcia
authors.initials: RG
authors.lastname: Espinosa
authors.forename: Carmen Arnal
authors.initials: CA
authors.lastname: Bertomeu
authors.forename: Mercedes
authors.initials: M
authors.lastname: Guillemot
authors.forename: Pedro Martinez
authors.initials: PM
authors.lastname: Casañ
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data*; D000758:Anesthesia / Q000009:adverse effects*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000706:statistics & numerical data*; D002769:Cholelithiasis / Q000503:physiopathology / Q000601:surgery*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D013997:Time Factors