Readmissions after laparoscopic cholecystectomy in a UK District General Hospital

Abstract

Laparoscopic cholecystectomy is the gold standard for the treatment of symptomatic gallstones and its practice as day case where possible is considered the standard over the last decade. However, readmission after surgery is recognised as a new problem. The aim of this cohort observational study was to investigate the readmission rate in a district general hospital and identify the causes of readmission in order to explore ways by which this can be reduced or managed more cost effectively. Records of patients who had laparoscopic cholecystectomy over 6months were retrospectively searched. Patients returning to hospital due to symptoms within 30days of elective and emergency laparoscopic cholecystectomy were included. Three hundred and twenty-eight laparoscopic cholecystectomies were performed within the 6-month period. Twenty-two patients returned within 30days of surgery making a readmission rate of 6.7%. Reasons for inpatient admission were abdominal pain without any underlying cause 10 (45.5%), wound infection 5 (22.7%), leg swelling 2 (9%), retained stone 1 (4.5%), bile leak 1 (4.5%), pneumonia 1 (4.5%), iatrogenic bowel injury 1 (4.5%) and back pain 1 (4.5%). Readmission rate decreased with longer duration of stay in hospital during primary admission, and 64% of patients returned to the hospital within 7days of procedure. 50% of patients who returned with abdominal pain without any identifiable cause had a longstanding history of conditions involving chronic pain. While the feared intra-abdominal complications of cholecystectomy often come to mind when assessing patients presenting with abdominal pain after surgery, non-specific abdominal pain is consistently shown to be several times more likely. A combination of patient factors and pain control techniques account for this pain. Effective multimodal pain management approach and community primary health care support in the early post-operative period could reduce readmission, save cost and improve patient experience.