ThTP6.1 Unplanned Admissions following Elective Laparoscopic Cholecystectomy Day Cases

Abstract

Abstract Background Laparoscopic Cholecystectomy (LC) represents a significant proportion of surgical caseload in the United Kingdom with over 50,000 operations per year (1). LC is recommended for patients with symptomatic gallstone disease (2). For appropriately selected patients, day case LC is recommended. British Association of Day Surgery (BADS) suggests a benchmark rate of 75% LC to be performed as day cases (3). Aim Retrospective audit of patient outcomes following elective day case LC, compared with national standards, to identify areas of improvements. Method Retrospective analysis of 100 elective planned day case LC at a District General Hospital between May 2021 - May 2022. Results 29 out of 100 patients had unplanned admissions. The most common reason for unplanned admission was intraoperative drain insertion (20/29, 69%), with 85% of these drains removed day 1 or 2 post op. Higher ASA grade patients were more likely to have unplanned admissions; 12.5% of ASA 1 patients vs 32.2% of ASA 2 patients vs 41.2% of ASA 3 patients. Patients with unplanned admissions had higher rates of subsequent re-admission (4/29; 13.8%), compared with day cases (3/71; 4.2%). Conclusion Our audit found the majority of ‘failed day cases’ were a result of intraoperative drain insertion. Drain insertion did not instigate further interventions, but did lengthen patients' stay. BADS recommend avoiding routine use of drains in LC and state that they can also be removed on the day of surgery (3). Our audit also highlights that high ASA cases should be performed earlier in the operative list, allowing for more time for observation to aid same-day discharge.