Day case laparoscopic cholecystectomy: reducing the admission rate.
BACKGROUND
The drive to achieving economy, efficiency and effective use of resources has catalysed the development of day case laparoscopic cholecystectomy (DCLC). The aims of this study were to determine the stay in (unplanned admission) rate of DCLC, identify reasons for unplanned admissions and re-admissions in this cohort of patients and explore how to improve the same day discharge rate.


METHODS
This is a review of 258 patients undergoing DCLC between April 2008 and March 2009. Information on these patients were retrieved and analysed for their effect on unplanned admission. Statistical analyses were performed using SPSS for Windows as appropriate.


RESULTS
There were 201 females and 57 males with mean ages of 44.23 ± 1.02 and 52.0 ± 1.83 respectively. Fifty six percent of patients had no major co-morbidities and 51% of operations were performed by consultants compared to 48% by Registrars (SpRs). The mean operation time was 50.92 ± 1.55 min for consultants and 61.36 ± 2.03 for SpRs (p = 0.0001). Sixty nine percent of the patients were discharged on same day after DCLC. The rate of admission was 29.4% for biliary colic, 37.7% for cholecystitis and 75% for those previously jaundiced. Admissions were mainly due to insertion of a drain and late operation start time.


CONCLUSIONS
Appropriate patient selection, sensible scheduling of operations and avoiding the use of drains will decrease unplanned admissions following DCLC. Although the time taken to perform procedures was higher for surgical trainees than consultants, this had no adverse outcome on patient outcome.
Akoh
Jacob A
JA
Department of Surgery, Level 04 Derriford Hospital, Plymouth PL6 8DH, United Kingdom. Jacob.akoh@phnt.swest.nhs.uk
Watson
Will A
WA
Bourne
Thomas P
TP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D017081:Cholecystectomy, Laparoscopic; D015331:Cohort Studies; D019091:Critical Pathways; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications; D012189:Retrospective Studies; D055815:Young Adult