title: Elective day-case laparoscopic cholecystectomy: a formal assessment of the need for outpatient follow-up.
abstract: BACKGROUND
  Elective laparoscopic cholecystectomy (LC) is performed routinely as day-case surgery. Most hospital trusts have a policy of no routine postoperative outpatient follow-up although there are no formal guidelines on this. The aim of this retrospective study was to identify the incidence of complications, the degree of symptom resolution and patient satisfaction with a view to formally appraising the need for outpatient follow-up.
  
  
  METHODS
  Patients who underwent LC in the period between February 2011 and June 2012 were contacted retrospectively by telephone. A standardised questionnaire was used to ascertain the incidence of surgical site infection (SSI), other complications, symptom resolution and patient satisfaction.
  
  
  RESULTS
  A total of 211 responses were collected. The rate of SSI was 7.6% (n=16), with the only specific risk factor being smoking (p=0.027). All other complications had a combined incidence of 7% (n=15). There was complete resolution of symptoms in 64% of patients. Of the 36% of patients with residual symptoms, 45% described abdominal discomfort or pain, 41% described reflux symptoms and 14% complained of diarrhoea. Patient satisfaction was very high (96%), yet 33% of patients visited their general practitioner postoperatively in relation to their surgery.
  
  
  CONCLUSIONS
  Patients are highly satisfied with elective day-case LC. However, SSI is not uncommon, occurring in 1 in 13 patients. Although the majority of patients experience complete symptom resolution, a significant proportion do not. In our experience, routine outpatient follow-up is not required. Nevertheless, the lack of formal follow-up may prove a missed learning opportunity, potentially resulting in inappropriate patient selection for surgery.
authors.affiliation: Wycombe Hospital, Queen Alexandra Road, High Wycombe, Buckinghamshire HP11 2TT, UK. gijs.vanboxel@gmail.com.
authors.forename: G I
authors.initials: GI
authors.lastname: van Boxel
authors.forename: M
authors.initials: M
authors.lastname: Hart
authors.forename: A
authors.initials: A
authors.lastname: Kiszely
authors.forename: S
authors.initials: S
authors.lastname: Appleton
mesh_terms: D000553:Ambulatory Care / Q000523:psychology; D000556:Ambulatory Surgical Procedures / Q000523:psychology; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000523:psychology; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000523:psychology / Q000628:therapy; D016896:Treatment Outcome