True day surgery or 23-hour admission for unselected elective laparoscopic cholecystectomy?

Abstract

Background Day case laparoscopic cholecystectomy in the UK is reported in selected patient groups but its role in managing the majority of patients with symptomatic gallstones is unclear. We examined use of the ambulatory surgery unit (ASU) for unselected elective laparoscopic cholecystectomy. Methods Data were collected for 1 year. High-risk patients with known bile duct calculi, BMI > 40 and/or previous upper abdominal open surgery were excluded from ASU laparoscopic cholecystectomy. Standard surgical or anaesthetic protocols were used and standard criteria for discharge were employed. Results In 1 year, 258 of 275 patients (94%) admitted for elective laparoscopic cholecystectomy via the ASU were discharged within 23 h of admission including 62 patients (23%) discharged on the day of surgery. There were 16 (5%) conversions to open surgery and 10 (4%) unplanned readmissions to inpatient beds. Forty ‘high-risk’ patients underwent laparoscopic cholecystectomy from inpatient beds of which 29 (73%) were discharged within 23 h. Conclusion The ASU is the optimal location for elective laparoscopic cholecystectomy to maximize day case throughput and minimize impact on inpatient bed occupancy.