HPB P31 Delayed discharges in day-case cholecystectomies, a real issue?

Abstract

Abstract Background Elective cholecystectomies are a very common general surgical procedure accounting for approximately 66660 cases a year and costing large amounts of resources to the NHS with significant regional variations in day-case rates1. Initiatives such as Get it Right First Time (GIRFT) aimed at improving the treatment of NHS patients are currently pushing for an increase in day-case rate to at least 75% of all cases and a decrease in regional variations2. The aim of this project was to determine how many patients underwent a day-case elective cholecystectomy, the percentage of delayed discharges and any reasons for the delay. Methods Retrospective analysis for which all adult patients admitted for a cholecystectomy at a district general hospital, in six consecutive months were included. For all included patients, ASA score, average age, length of stay, diagnosis and reason for delayed discharge were recorded. Reported complications were also included in the analysis. All data was collected via screening of local electronic health records. Results 217 patients were included in the analysis. 58% were discharged on the same day; of those not discharged on the same day non-elective operations and planned elective inpatients accounted for 28% and 17% of the total respectively. 75% of all included patients was female and all planned day-cases patients were either ASA1 or 2. Reasons for delayed discharge of planned day-cases included drain placement (18%), social issues (4%), nausea and pain (10%), not meeting discharge criteria such as inability of passing urine (14%) and for 24% of patients no reason was recorded. Conclusions Studies have shown that the combination of high ASA and increasing age reduce the likelihood of same day discharge.3 Our study found documentation to be often inaccurate and a potential for better pre-operative selection of patients in order to ensure high levels of safe day-case cholecystectomies.