The learning curve in ambulatory laparoscopic cholecystectomy.
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.
Serra
Alfonso Serralta
AS
Instituto de Cirugía General y del Aparato Digestivo, Clinica Quiron, Valencia, Spain.
Roig
Manuel Planells
MP
Lledo
Jose Bueno
JB
Santafe
Angel Sanahuja
AS
Espinosa
Rafael Garcia
RG
Bertomeu
Carmen Arnal
CA
Guillemot
Mercedes
M
Casañ
Pedro Martinez
PM
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