title: [Intraoperative factors predictive of failure of the ambulatory regimen after laparoscopic cholecystectomy].
abstract: OBJECTIVE
  To determine which intraoperative factors during ambulatory laparoscopic cholecystectomy predict postoperative admission.
  
  
  METHODS
  Between January 1999 and August 2003, we attempted 410 consecutive laparoscopic cholecystectomies. Intraoperative variables were analyzed using univariate and multivariate methods. An intraoperative score was applied to determine the probability of successful ambulatory surgery in each patient.
  
  
  RESULTS
  A total of 88.5% of the patients were strictly ambulatory. Forty-two patients required overnight admission, mostly due to social factors, and five patients required admission after 24-48 hours. Intraoperative variables predictive of postoperative admission were an operating time of more than 60 minutes (p = 0.011), gallbladder dissection with anatomic difficulty (p = 0.001), and cystic artery hemorrhage (p = 0.041). Surgical access to the abdominal cavity, gallbladder perforation, trocar wound or hepatic bed bleeding, intensity or grade of hemorrhage, and gallbladder extraction were not predictive variables.
  
  
  CONCLUSIONS
  Ambulatory laparoscopic cholecystectomy is a safe and effective procedure. Operating time, correct dissection of gallbladder structures and hemorrhage of the gallbladder hilus, especially of the cystic artery, play a major role in the success or failure of ambulatory laparoscopic cholecystectomy.
authors.affiliation: Servicio de Cirugía, Instituto de Cirugía General y del Aparato Digestivo, ICAD, Clínica Quirón, Valencia, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Bueno-Lledó
authors.forename: Manuel
authors.initials: M
authors.lastname: Planells-Roig
authors.forename: Angel
authors.initials: A
authors.lastname: Sanahuja-Santafé
authors.forename: Rafael
authors.initials: R
authors.lastname: García-Espinosa
authors.forename: Consuelo
authors.initials: C
authors.lastname: Arnau-Bertomeu
authors.forename: Mercedes
authors.initials: M
authors.lastname: Guillemot
mesh_terms: D000556:Ambulatory Surgical Procedures; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D017211:Treatment Failure