Transitions in laparoscopic cholecystectomy: the impact of ambulatory surgery.

Abstract

Ambulatory laparoscopic cholecystectomy is a common practice in the United States, but its development remains slow in most other countries. The objective of the current study was to report the impact of ambulatory surgery on the practice of laparoscopic cholecystectomy in a major teaching hospital since the inception of the service. The hospital database of patients who underwent cholecystectomies for benign hepatobiliary pathologies was reviewed between January 1993 and December 1999. Changes in the practice of laparoscopic cholecystectomy and the length of hospital stay were analyzed. Clinical characteristics of the ambulatory and inpatient groups were compared. Of 2,891 laparoscopic cholecystectomies involved in the current study, 888 (31%) were performed as day cases, and 2,003 (69%) were performed as inpatient laparoscopic cholecystectomies. The annual number of ambulatory laparoscopic cholecystectomies increased from 3 (0.6%) in 1993 to 212 (48%) in 1997. This was followed by a plateau in the next 3 years. The ambulatory group comprised a significantly higher prevalence of young women (87%) who underwent surgery mainly for biliary colic (88%). The current study demonstrated a net trend toward ambulatory laparoscopic cholecystectomy and a shorter length of hospital stay. Almost half of our patients with gallstone disease currently are using the ambulatory laparoscopic cholecystectomy service, with young women constituting the majority. We predict that ambulatory laparoscopic cholecystectomy heralds the wave of the future, and our experience may serve as a blueprint for other institutions wishing to embark on this journey.