Introduction of a day-case laparoscopic cholecystectomy service in the UK: a critical analysis of factors influencing same-day discharge and contact with primary care providers.
BACKGROUND
The objective of this study was to determine the safety and acceptability of the implementation of a day-case laparoscopic cholecystectomy (LC) service in a large UK teaching hospital, and analyse factors influencing contact with primary care providers. Wide-spread introduction of day-case LC in the UK is a major target of healthcare providers. However, few centres have reported their experience. In the US, out-patient surgery for LC has been reported, though many groups have utilised 24-h observation units to facilitate discharge. Concerns remain amongst surgeons regarding the feasibility and acceptability of the introduction of day-case LC in the UK.


METHODS
Comprehensive care and operative data were prospectively collected on the first 106 consecutive day-case procedures in our hospital. Postoperative recovery was monitored by telephone questionnaire on days 2, 5 and 14, including complications, satisfaction and general practitioner consultation.


RESULTS
A total of 106 patients were admitted for day-case LC, of whom 84% were discharged on the day of surgery. Patient satisfaction rate was 94% in both the successful day-case and the admitted patients. Mean operation time was 62 min, with an average total stay on the day-care unit of 426 min. Training-grade surgeons performed 31% of operations. Both the readmission rate after surgery and rate of conversion to open surgery were 2%. Advice from primary healthcare providers was sought by 33% of patients within the first 14 postoperative days.


CONCLUSIONS
Introduction of day-case LC in the UK is feasible and acceptable to patients. The potential burden to primary care providers needs further study.
Briggs
C D
CD
Department of Hepatobiliary and Pancreatic Surgery, Royal Hallamshire Hospital, Sheffield, UK. chrisbriggs@doctors.org.uk
Irving
G B
GB
Mann
C D
CD
Cresswell
A
A
Englert
L
L
Peterson
M
M
Cameron
I C
IC
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010044:Outpatient Clinics, Hospital; D010149:Postoperative Pain; D010351:Patient Discharge; D010359:Patient Readmission; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D006113:United Kingdom; D055815:Young Adult