title: Is standardized care feasible in the emergency setting? A case matched analysis of patients undergoing laparoscopic cholecystectomy.
abstract: BACKGROUND
  Immediate laparoscopic cholecystectomy is the accepted standard for the treatment of acute cholecystitis. The aim of the present study was to evaluate the feasibility of a standardized approach with tailored care maps for pre- and postoperative care by comparing pain, nausea and patient satisfaction after elective and emergent laparoscopic cholecystectomy.
  
  
  METHODS
  From January 2014 until April 2015, data on pain and nausea management were prospectively recorded for all elective and emergency procedures in the department of visceral surgery. This prospective observational study compared consecutive laparoscopic elective vs. emergency cholecystectomies. Visual analogue scales (VAS) were used to measure pain, nausea, and satisfaction from recovery room until 96 hours postoperatively.
  
  
  RESULTS
  Final analysis included 168 (79%) elective cholecystectomies and 44 (21%) emergent procedures. Demographics (Age, gender, BMI and ASA-scores) were comparable between the 2 groups. In the emergency group, patients did not receive anxiolytic medication (0% vs.13%, p = 0.009) and less postoperative nausea and vomiting (PONV) prophylaxis (77% vs. 97% p = <0.001). Perioperative pain management was similar in terms of opioid consumption (median amount of fentanyl 450ug [IQR 350-500] vs. 450ug [375-550], p = 0.456) and wound infiltration rates (24% vs. 25%, p = 0.799). Postoperative consumption of paracetamol, metamizole and opiod medications were similar between the 2 groups. VAS scores for pain (p = 0.191) and nausea (p = 0.392) were low for both groups. Patient satisfaction was equally high in both clinical settings (VAS 8.5 ± 1.1 vs. 8.6 ± 1.1, p = 0.68).
  
  
  CONCLUSIONS
  A standardized pathway allows equally successful control of pain and nausea after both elective and emergency laparoscopic cholecystectomy. This study was retrospectively registered by March 01, 2016 in the following trial register: www.researchregistry.com (UIN researchregistry993).
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Grass
authors.affiliation: Department of Anaesthesiology, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Cachemaille
authors.affiliation: Department of Anaesthesiology, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: Catherine
authors.initials: C
authors.lastname: Blanc
authors.affiliation: Institute for Social and Preventive Medicine, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Fournier
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Nermin
authors.initials: N
authors.lastname: Halkic
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland. demartines@chuv.ch.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Hübner
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000592:standards*; D041881:Cholecystitis, Acute / Q000601:surgery*; D019091:Critical Pathways; D017558:Elective Surgical Procedures / Q000592:standards; D004630:Emergencies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting; D011446:Prospective Studies
keywords: Cholecystectomy; Elective; Emergent; Pain management; Postoperative