Background
Day case laparoscopic cholecystectomy (DCLC) is a known safe alternative to overnight stay procedure in suitable patient cohorts. It reduces pre-surgical wait times and cost-effective, whilst not compromising patient care1. Despite strict protocol adherence, some patients required unplanned admission post-operatively. We seek to identify the barriers to successful discharge for DCLC in our institution- a non-tertiary hospital in Victoria.
Methods
A retrospective study of patients who underwent elective DCLC during a 12-month period in 2023 and 2024 was performed. Collected data include patient’s demographics, comorbidities, intra-operative details, operator experience and post operative complications. Comparative analysis and multivariable logistic regression performed to identify associations between exposure variables and discharge failure, adjusted for age and sex.
Results:
There were 77 (55 females, 22 males) patients with mean age of 44.2 (SD:11.9). Of these, 60% were successfully discharged on the same day. The most common reason for unplanned overnight admissions were due to symptoms in recovery including pain, nausea and vomiting (35%). There is a significant association between discharge failure and high BMI (p=0.047; OR:3.41, CI:1.02,11.4). There is no association observed with previous surgery, history of chronic pain and primary operator's experience.
Conclusion
Obese patients (BMI ≥ 30) may not be suitable candidates for DCLC. Prompt reviews and management of immediate post operative symptoms are important to reduce unplanned overnight admission. We propose DCLC remains a safe and cost-effective alternative in a non-tertiary facility. However, revision of patient selection criteria and post operative pathway algorithm are necessary to ensure successful implementation.