Day-case laparoscopic cholecystectomy: treatment of choice for selected patients?
BACKGROUND
The authors report their 7-year experience with day-case laparoscopic cholecystectomy (LC) to determine its applicability, safety, and cost effectiveness.


METHODS
Of 920 consecutive patients who underwent elective LC over a 7-year period, 567 (62%) were scheduled for day-case surgery. The median age of the patients was 48 years (range, 16-74 years), and the male/female ratio was 148/419. The selection criteria required an American Society of Anesthesiologists (ASA) grade of 1 or 2, absence of morbid obesity, low risk of common bile duct stones, adult company at home, and residence within 100 km of the hospital. The LC procedure was performed using a standard four-cannula technique. Propofol-opiate-rocuron-sevoflurane anesthesia, prophylactic antiemetics, and preemptive analgesia were administered in all cases.


RESULTS
The mean length of the operation was 56 +/- 18 min. There was no hospital mortality, and 7 (1.2%) of 567 patients required conversion to open cholecystectomy. Approximately 356 (63%) of the 567 patients were discharged home on the same day as the operation, whereas 211 patients (37%) were admitted overnight after the operation because of social reasons (13.7%), surgeon preference (15.2%), nausea and/or pain (15.2%), operation late in the afternoon (14.2%), or patient preference (41.7%). There were no serious complications. A total of 22 patients visited the emergency unit, and 7 patients required readmission, giving a readmission rate of 2%. The overall postoperative morbidity rate was 6% (n = 22), with morbidities including retained stones (n = 2), bile leakage (n = 1), and pneumonia (n = 1). The mean procedural cost to the hospital was 1,836 euros for day-case LC, as compared with 2,712 euros for an inpatient operation.


CONCLUSIONS
For selected patients, day-case LC is feasible and safe, providing a substantial reduction in hospital costs.
Victorzon
M
M
Department of Gastrointestinal Surgery, Vaasa Central Hospital, Hietalahdenkatu 2-4, 65130, Vaasa, Finland. mikael.victorzon@vshp.fi
Tolonen
P
P
Vuorialho
T
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000191:economics; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000191:economics; D003362:Cost-Benefit Analysis; D004638:Emergency Treatment; D005240:Feasibility Studies; D005260:Female; D005705:Gallbladder Diseases / Q000175:diagnosis / Q000601:surgery*; D017048:Health Care Costs; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D018579:Patient Selection; D011184:Postoperative Period; D011300:Preoperative Care; D013997:Time Factors; D016896:Treatment Outcome