Risk Factors for Patient Selection in Ambulatory Laparoscopic Cholecystectomy: A Single-centre Experience

Overview

Journal J Minim Access Surg

Specialty Gastroenterology

Date 2022 Mar 22

PMID 35313439

Authors

Qiang Wu

Ning Fu

Weiwei Chen

Xueli Jin

Lei He

Chencheng Mo

Jiao Chen

Daoyun Luo

Minkun Ma

Hongqiang Yang

Jingcheng Hao

Affiliations

Soon will be listed here.

Abstract

Backgrounds: Ambulatory laparoscopic cholecystectomy (LC) reduces healthcare cost and increases hospital bed capacity. Currently, there is no consensus on patient selection for ambulatory LC. Evaluation of risk factors for ambulatory discharge is essential.

Materials And Methods: Consecutive patients who underwent LC in our centre throughout 2019 were collected. We evaluated the discharge fitness using the Post-Anaesthetic Discharge Scoring System at 8 h after the operation. The relations between pre-operative variables and dischargeable possibilities were analysed for screening risk factors. Furthermore, we performed a literature review to summarise all published information.

Results: Six hundred and forty-one cases were included in this study. American Society of Anaesthesiologist (ASA) grading (odds ratio OR = 0.415, P = 0.001) and leucocytes (OR = 0.80, P < 0.001) significantly predicted the fitness of discharge. ASA contributed to lower activity (P = 0.002) and intake/output (P = 0.006) scores. Leucocytes influence the vital sign (P < 0.001) and pain or post-operative nausea and vomiting (PONV) (P < 0.001) scores. The prolonged operation could predict the inabilities of discharge with a cut-off value of 55 min by dropping vital signs (P = 0.011), activity (P < 0.001) and pain or PONV (P = 0.012) scores. Male sex (OR: 1.702, P = 0.010), body mass index (BMI) (OR: 1.087, P = 0.008), leucocytes (OR: 1.075, P = 0.017) and C-reactive protein (CRP) (OR: 1.018, P = 0.003) were predictors for prolonged operation (>55 min).

Conclusions: We suggest that pre-operative ASA grading III and leucocytes are risk factors for the fitness of ambulatory discharge after LC and intraoperative time. Male, BMI and CRP predict complicated surgery, and they should be considered preoperatively.

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References

Briggs C, Irving G, Mann C, Cresswell A, Englert L, Peterson M . Introduction of a day-case laparoscopic cholecystectomy service in the UK: a critical analysis of factors influencing same-day discharge and contact with primary care providers. Ann R Coll Surg Engl. 2009; 91(7):583-90. PMC: 2966163. DOI: 10.1308/003588409X432365. View

Psaila J, Agrawal S, Fountain U, Whitfield T, Murgatroyd B, Dunsire M . Day-surgery laparoscopic cholecystectomy: factors influencing same-day discharge. World J Surg. 2007; 32(1):76-81. DOI: 10.1007/s00268-007-9225-x. View

Fried G, Barkun J, Sigman H, Joseph L, Clas D, Garzon J . Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. Am J Surg. 1994; 167(1):35-9; discussion 39-41. DOI: 10.1016/0002-9610(94)90051-5. View

Voitk A . Is outpatient cholecystectomy safe for the higher-risk elective patient?. Surg Endosc. 1997; 11(12):1147-9. DOI: 10.1007/s004649900557. View

Brescia A, Gasparrini M, Nigri G, Cosenza U, DallOglio A, Pancaldi A . Laparoscopic cholecystectomy in day surgery: feasibility and outcomes of the first 400 patients. Surgeon. 2012; 11 Suppl 1:S14-8. DOI: 10.1016/j.surge.2012.09.006. View

Akoh J, Watson W, Bourne T . Day case laparoscopic cholecystectomy: reducing the admission rate. Int J Surg. 2010; 9(1):63-7. DOI: 10.1016/j.ijsu.2010.09.002. View

Mattila A, Mrena J, Kautiainen H, Nevantaus J, Kellokumpu I . Day-care laparoscopic cholecystectomy with diathermy hook versus fundus-first ultrasonic dissection: a randomized study. Surg Endosc. 2015; 30(9):3867-72. DOI: 10.1007/s00464-015-4691-y. View

Rao A, Polanco A, Qiu S, Kim J, Chin E, Divino C . Safety of outpatient laparoscopic cholecystectomy in the elderly: analysis of 15,248 patients using the NSQIP database. J Am Coll Surg. 2013; 217(6):1038-43. DOI: 10.1016/j.jamcollsurg.2013.08.001. View

Chung F, Chan V, Ong D . A post-anesthetic discharge scoring system for home readiness after ambulatory surgery. J Clin Anesth. 1995; 7(6):500-6. DOI: 10.1016/0952-8180(95)00130-a. View

10.

Qu J, Xin C, Wang G, Yuan Z, Li K . Feasibility and safety of single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy in an ambulatory setting. Hepatobiliary Pancreat Dis Int. 2019; 18(3):273-277. DOI: 10.1016/j.hbpd.2019.04.008. View

11.

Nidoni R, Udachan T, Sasnur P, Baloorkar R, Sindgikar V, Narasangi B . Predicting Difficult Laparoscopic Cholecystectomy Based on Clinicoradiological Assessment. J Clin Diagn Res. 2016; 9(12):PC09-12. PMC: 4717755. DOI: 10.7860/JCDR/2015/15593.6929. View

12.

Mok K, Goh Y, Howell L, Date R . Is C-reactive protein the single most useful predictor of difficult laparoscopic cholecystectomy or its conversion? A pilot study. J Minim Access Surg. 2016; 12(1):26-32. PMC: 4746971. DOI: 10.4103/0972-9941.158963. View

13.

Livingston E, Rege R . A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg. 2004; 188(3):205-11. DOI: 10.1016/j.amjsurg.2004.06.013. View

14.

Bailey C, Ahuja M, Bartholomew K, Bew S, Forbes L, Lipp A . Guidelines for day-case surgery 2019: Guidelines from the Association of Anaesthetists and the British Association of Day Surgery. Anaesthesia. 2019; 74(6):778-792. DOI: 10.1111/anae.14639. View

15.

Sakuramoto S, Sato S, Okuri T, Sato K, HIKI Y, Kakita A . Preoperative evaluation to predict technical difficulties of laparoscopic cholecystectomy on the basis of histological inflammation findings on resected gallbladder. Am J Surg. 2000; 179(2):114-21. DOI: 10.1016/s0002-9610(00)00248-8. View

16.

Singh D, Joshi M, Koirala U, Shrestha B, Shrestha S, Gautam B . Early experience of day care surgery in Nepal. JNMA J Nepal Med Assoc. 2011; 49(179):191-4. View

17.

Hayama S, Ohtaka K, Shoji Y, Ichimura T, Fujita M, Senmaru N . Risk Factors for Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis. JSLS. 2016; 20(4). PMC: 5081400. DOI: 10.4293/JSLS.2016.00065. View

18.

Seleem M, Gerges S, Shreif K, Ahmed A, Ragab A . Laparoscopic cholecystectomy as a day surgery procedure: is it safe?--an egyptian experience. Saudi J Gastroenterol. 2011; 17(4):277-9. PMC: 3133987. DOI: 10.4103/1319-3767.82584. View

19.

Chang S, Tan W . Feasibility and safety of day surgery laparoscopic cholecystectomy in a university hospital using a standard clinical pathway. Singapore Med J. 2008; 49(5):397-9. View

20.

Russell J, Walsh S, Reed-Fourquet L, Mattie A, Lynch J . Symptomatic cholelithiasis: a different disease in men? Connecticut Laparoscopic Cholesystectomy Registry. Ann Surg. 1998; 227(2):195-200. PMC: 1191235. DOI: 10.1097/00000658-199802000-00007. View