title: Analysis of delayed discharge after day-surgery laparoscopic cholecystectomy.
abstract: BACKGROUND
  Delayed discharge is the existing obstacle to further enhancing quality of recovery after Day-surgery laparoscopic cholecystectomy (LC/DS). This study aims to analyze the reasons for delayed discharge after LC/DS.
  
  
  METHODS
  The 745 patients with delayed discharge after LC/DS were retrospectively studied. The reasons for delayed discharge and data related to patients were collected and analyzed. Psychosocial reasons were defined by meeting discharge criteria but refusing to discharge, and complications were defined and graded using the "Clavien-Dindo" classification system. Differences were statistically significant when p-value < 0.01 level.
  
  
  RESULTS
  The reasons for delayed discharge included psychosocial reasons (P, n = 324), conversion to open surgery (CO, n = 21) and Clavien-Dindo I (n = 72), II (n = 307), IIIa (n = 17), IVa (n = 4) complications. Group P had a shorter length of postoperative hospital stay (PHT) compared to groups I, II, IIIa, IVa and CO (p < 0.01, respectively). Group II had a longer operation time (p < 0.01) but no longer length of PHT (p = 0.814) compared to group I. The length of PHT in group IIIa was longer than that in groups I and II (p < 0.01, respectively), but the length of PHT in group IVa was no longer than that in groups I, II, and IIIa (p = 0.047, p = 0.044 and p = 0.849, respectively). Group CO had a longer operation time (p < 0.01, respectively), a more blood loss (p < 0.01, respectively) and a longer length of PHT (p < 0.01, respectively) compared to groups P, I, II, and IIIa.
  
  
  CONCLUSIONS
  Patients who are delayed discharge due to psychosocial reasons have a rapid postoperative recovery. The slower postoperative recovery and upgraded complication classifications are related and optimized medical procedures promote the recovery. It is reasonable for patients who undergo conversion to open surgery to experience a slow postoperative recovery.
authors.affiliation: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian, Beijing 100853, China.
authors.forename: Junning
authors.initials: J
authors.lastname: Cao
authors.affiliation: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian, Beijing 100853, China. Electronic address: jnliubo@sohu.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Liu
authors.affiliation: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian, Beijing 100853, China.
authors.forename: Xiangjun
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian, Beijing 100853, China.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Leng
authors.affiliation: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian, Beijing 100853, China.
authors.forename: Xiangfei
authors.initials: X
authors.lastname: Meng
authors.affiliation: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian, Beijing 100853, China.
authors.forename: Yingwei
authors.initials: Y
authors.lastname: Pan
authors.affiliation: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian, Beijing 100853, China.
authors.forename: Songmeng
authors.initials: S
authors.lastname: Dou
authors.affiliation: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian, Beijing 100853, China.
authors.forename: Shichun
authors.initials: S
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods / Q000706:statistics & numerical data*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000145:classification* / Q000209:etiology / Q000523:psychology; D011184:Postoperative Period; D012189:Retrospective Studies; D013997:Time Factors
keywords: Day surgery; Delayed discharge; Laparoscopic cholecystectomy; Reason; “Clavien-Dindo” classification