Elective Laparoscopic Cholecystectomy Research Articles

Comparison of efficacy of intraoperative intravenous 5% dextrose versus intravenous ringer lactate for prevention of postoperative nausea and vomiting in patients undergoing elective laparoscopic cholecystectomy.

Objective: To assess the effectiveness of intraoperative intravenous 5% dextrose in contrast to intravenous Ringer lactate for averting postoperative nausea and vomiting among individuals undergoing elective laparoscopic cholecystectomy at a Tertiary Care Hospital in Karachi. Study Design: Randomized Control Trial. Setting: Department of Anesthesia, Dow University of Health Sciences, Located at Civil Hospital in Karachi. Period: 25-09-20 to 25-03-21. Methods: Patient data was collected in a prospective manner following verbal consent. A total of 60 patients, meeting the diagnostic criteria, were incorporated in the study. A concise medical history was obtained, and demographic details were recorded in the performa. Data was all variables were collected and analysed using SPSS version 22. Results: This study encompassed a total of 60 patients. In the dextrose group, the mean age, duration of surgery, length of hospital stay, height, weight, and BMI were 48.21±6.24 years, 2.54±1.78 hours, 4±2.54 days, 147±4.21 cm, 71.7±7.25 kg, and 28.9±5.14 kg/m2, respectively. Conversely, in the ringer lactate group, these values were 49.48±8.41 years, 2.97±1.56 hours, 4±1.89 days, 158±5.28 cm, 78.7±9.87 kg, and 29.6±4.91 kg/m2. The efficacy for preventing postoperative nausea and vomiting was 80% for the dextrose group and 36.7% for the ringer lactate group in our study. Conclusion: Administering preoperative fluid supplementation with dextrose resulted in a reduced occurrence of postoperative nausea and vomiting (PONV) in comparison to ringer lactate.

Short- and long-term predictive power of the preoperative Geriatric Assessment components in older patients undergoing cholecystectomy.

Introduction: Increasing numbers of older patients will require laparoscopic cholecystectomies. Physicians may have doubts when qualifying these patients for elective surgeries, since older age is considered a risk factor for complications. Determining biological age, using a Geriatric Assessment (GA), should be the key factor in the preoperative assessment. The goal of this study was to determine which GA components are most useful for predicting postoperative outcomes in both short- and long-term follow-up.Materials and Methods: 219 consecutive patients aged ≥70 years underwent surgery and were followed-up prospectively for 12 months. The preoperative GA consisted of functionality, physical activity, comorbidity, polypharmacotherapy, nutrition, cognition, mood, and social support domain. Logistic regression analyses were used to analyse the predictive ability of the GA. Results: GA, frailty and chronological age were not predictive of major 30-day morbidity. There were significantly more overall postoperative complications in the frail group, mainly minor and medical. There were no significant differences in the rate of major and surgical complications between frail and fit patients. Only frailty was a predictor of 1-year mortality. Conclusion: Performing GA before elective laparoscopic cholecystectomies seems unnecessary for the evaluation of short-term outcomes but helpful for the assessment of long-term outcomes. Laparoscopic cholecystectomy can be safely performed also in older frail patients.

Opioid-free anesthesia using a combination of ketamine and dexmedetomidine in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial

Background: Opioids administered as bolus doses or continuous infusions are widely used by anesthesiologists worldwide for major and day care surgeries. Opioid-free anesthesia is a multimodal anesthesia and analgesia technique that does not use opioid drugs, thereby benefitting patients from opioid-related adverse effects. In this study, we compared the postoperative analgesic requirements of patients scheduled for elective laparoscopic cholecystectomy under opioid-free and opioid-based anesthesia.Methods: This study included 88 patients aged 18–60 years with American Society of Anesthesiologists physical status 1 and 2 who underwent elective laparoscopic cholecystectomy. Participants were randomly divided into two groups with forty-four participants in each group. The opioid-free anesthesia group was administered an intravenous bolus of ketamine and dexmedetomidine, whereas the opioid-based group was administered fentanyl with conventional general anesthesia. The primary outcome was to compare the total amount of fentanyl consumed by both groups during the 6 h postoperative period following extubation. Episodes of postoperative nausea and vomiting (PONV) and vital signs were noted throughout the postoperative period to analyze the secondary outcomes.Results: Both the groups had similar demographic characteristics. The opioid-free group required less postoperative analgesia within the first 2 h (61.4 ± 17.4 vs. 79.0 ± 19.4 of fentanyl, P < 0.001), which was statistically significant. However, fentanyl consumption was comparable between the groups at the sixth postoperative hour (opioid-free group 152 ± 28.2 vs. opioid group 164 ± 33.4, P = 0.061). Compared with 4.5% of the participants in the opioid-free group, 34% of those in the opioid-based group developed moderate PONV.Conclusions: The opioid-free anesthesia technique in patients undergoing laparoscopic cholecystectomy reduced the requirement of analgesia in the first two hours of the postoperative period and was associated with decreased PONV.

Laparoscopic cholecystectomy in calculous cholecystitis: are antibiotics necessary?

Laparoscopic cholecystectomy in patients with cholecystitis is considered the best, appropriate and safe method of treatment for gallstone disease. However, the role of antibiotic administration before or after cholecystectomy to reduce infectious complications, particularly surgical site infections, or mortality is less clear. Many patients receive empiric antibiotics, but the feasibility of their use has not been proven. Some guidelines suggest the use of antibiotic prophylaxis for all cholecystectomies, although current evidence does not indicate any benefit to this practice in the absence of risk factors. This review examines the results of antibiotic use in laparoscopic cholecystectomy for chronic and acute calculous cholecystitis. Most studies argue against the need to use prophylactic antibiotics during elective surgery in low-risk patients. In cases of mild and moderate acute cholecystitis, the use of antibiotics to prevent postoperative infectious complications has no evidence of effectiveness, although these recommendations are also ambiguous. It is not recommended to use postoperative antibiotics after elective laparoscopic cholecystectomy, as well as for mild or moderate acute cholecystitis. However, additional studies with well-defined patient populations and comparable outcomes are needed to better assess the most appropriate timing and duration of antibiotic use in patients undergoing laparoscopic cholecystectomy. We used MedLine database on the PubMed platform and the Cochrane library to search for literature sources.

Laparoscopic cholecystectomy performed by a surgical care practitioner: a review of outcomes.

Surgical care practitioners (SCPs) are non-medical workers involved in various aspects of the management of surgical patients. The role includes assisting and performing surgical procedures. More than 60,000 laparoscopic cholecystectomies (LC) are performed annually in the UK. With ever-increasing pressure on waiting lists, it is important to look at fully utilising the skills of our entire workforce. We report what we believe is the first published series of LC performed by an SCP. A retrospective review of a prospectively collected database was performed. The primary outcome was any complication requiring intervention. Secondary outcomes were minor complications, operative time, length of stay, conversion and readmission. In total, 170 patients were operated on. Indications were biliary colic in 127 (74.7%), cholecystitis in 30 (17.6%) and pancreatitis in 13 (7.6%). Mean operating time was 65min (range 35-152min). Fifty-three operations were assisted by a consultant, 110 by a specialist or associate specialist grade (SAS) doctor and 7 by a core trainee (CT2). Some 139 (81.7%) patients were discharged on the day of surgery and 24 (14.1%) stayed one night in hospital. There were no major complications. Five patients required readmission, three with pain and two with port site infections. There were no conversions or transfusions required. There is a paucity of published data on surgical outcomes of procedures performed by SCPs. With a structured, supervised approach, SCPs could be trained to take on more complex procedures and further strengthen the surgical workforce. This study demonstrates that elective LC can be safely performed by an appropriately trained and supervised SCP.

The incidences of nausea and vomiting after general anesthesia with remimazolam versus sevoflurane: a prospective randomized controlled trial.

Postoperative nausea and vomiting (PONV) refers to nausea and vomiting that occurs within 24-h after surgery or in the post-anesthesia care unit (PACU). Previous studies have reported that the use of remimazolam, a newer benzodiazepine (BDZ) hypnotic, for anesthesia results in less PONV. In this study, we compared the rate of PONV between sevoflurane and remimazolam after general anesthesia. In this prospective randomized controlled trial (RCT), participants aged 20-80 years who underwent elective laparoscopic cholecystectomy or hemicolectomy were randomized to either the remimazolam or sevoflurane group. The primary outcome was PONV incidence for 24-h after surgery. Secondary outcomes comprised of PONV at 30-min post-surgery, postoperative additional antiemetic use, and Quality of Recovery-15 (QOR-15) score at 24-h postoperatively. Forty patients were enrolled in the study. The remimazolam group exhibited significantly lower rates of PONV for 24-h after surgery than did the sevoflurane group (remimazolam group vs. sevoflurane group; 5% vs. 45%, P = 0.003, respectively). The use of dexamethasone, a rescue antiemetic administered within 24 h of surgery, was substantially lower in the remimazolam group than in the sevoflurane group (0% in remimazolam vs. 30% in sevoflurane, P = 0.020). The QOR-15 score at 24-h after surgery showed no significant difference between the two groups. Compared to sevoflurane, opting for remimazolam as an intraoperative hypnotic may decrease the incidence of PONV and reduce antiemetic use for 24 h after laparoscopic surgery.

Evaluation of the Effects of Magnesium Sulphate versus Normal Saline on Hemodynamics in Patients Undergoing Laparoscopic Cholecystectomy

Introduction: Numerous studies have shown that giving magnesium sulphate intravenously before carbon dioxide pneumoperitoneum is produced reduces the adverse hemodynamic response in patients undergoing elective laparoscopic cholecystectomy. 
 Objective: To examine the effects on hemodynamics in patients undergoing laparoscopic cholecystectomy between magnesium sulphate and normal saline.
 Methodology:The Department of Anaesthesia at the Pakistan Institute of Medical Sciences, SZABMU, Islamabad, conducted a Randomised Clinical Trial. The study involved the enrolment of 108 adult patients, regardless of gender, who were admitted for elective laparoscopic cholecystectomy and ranged in age from 18 to 65. Every patient who was enrolled was in ΑSΑ classes I and II. Patients were randomised equally to Group M, which received an IV slow bolus of magnesium sulphate (28 mg/kg) over a 20-minute period, and Group N, which received a 0.9% normal saline solution. The patient was tilted right and up by 15 degrees.
 Results:Both groups' baseline characteristics were comparable. The mean age of groups M and N was 42.2 years ± 7.6SD and 40.5 years ± 8.4SD, respectively (Ρ-value t-test=0.258). 22 (40.7%) men and 32 (59.3%) women made up group M, while 20 (37.0%) men and 34 (63.0%) women made up group N (Ρ-value chi-square = 0.693).  Both groups' baseline and pre-pneumoperitoneum hemodyanamic parameters (HR, Systolic, BΡ, Diastolic BΡ, and MAΡ) were similar (Ρ-value t-test > 0.05).
 Conclusions:The adverse hemodynamic response caused by pneumoperitoneum was significantly attenuated by pretreatment with intravenous magnesium sulphate. Heart rate, systolic blood pressure, diastolic blood pressure, and MTH were all significantly lower than baseline. Significant hypotension and bradycardia, however, were not seen. 

Haemodynamic responses to intubation, extubation and post‐operative analgesia after intravenous lignocaine in laparoscopic cholecystectomy surgeries: a randomized control study

ABSTRACT:
 Objectives: To evaluate the effect of intravenous lignocaine on haemodynamic responses to intubation, extubation and post‐operative analgesia in laparoscopic cholecystectomy surgeries.
 Methods: This prospective, randomized, double blinded study was conducted in patients for elective laparoscopic cholecystectomy surgery in tertiary care hospital of Tamil Nadu. Group A (n=60) received 0.9% normal saline for perioperative intravenous infusion and Group B (n=60) received preservative free lignocaine 2% (20mg/ml) as intravenous infusion Hemodynamic responses were recorded to intubation, extubation and post‐operative analgesia in both groups. VAS scores and pain free period were also compared.
 Results: Pulse rate (PR) and mean arterial pressure (MAP) were significantly increased in both the groups during laryngoscopy and intubation, though the rise of both in lignocaine group was significantly less than normal saline group. (p<0.0001)  Similarly, both PR and MAP were significantly increased during extubation in both the groups. (p<0.0001) However, the rise of both the parameters in lignocaine group was significantly less as compared to normal saline group. (p<0.0001) VAS scores in immediate post operative period were better in lignocaine group than normal saline group. The mean pain free period was less than an hour in normal saline group, while it was approximately 4 hours in lignocaine group. (p<0.0001)
 Conclusions: This study concluded that i.v infusion of lignocaine had significantly increased the pain free period post operatively. So those who are not affordable for epidural block, lignocaine i.v infusion is better alternative for post operative analgesia.

Association of day-case rates with post COVID-19 recovery of elective laparoscopic cholecystectomy activity across England.

The aim of this study was to investigate the safety of day-case laparoscopic cholecystectomy, and the association between day-case rates and, post the COVID-19 pandemic, recovery of activity to prepandemic levels for integrated care boards (ICBs) in England. This was a retrospective observational study of the Hospital Episodes Statistics (HES) data set. Elective laparoscopic cholecystectomies for the period 1 January 2019 to 31 December 2022 were identified. Activity levels for 2022 were compared with those for the whole of 2019 (baseline). Day-case activity was identified where the length of stay recorded in the HES was zero days. Data were available for 184,252 patients across the 42 ICBs in England, of which 120,408 (65.3%) were day-case procedures. By December 2022, activity levels for the whole of England had returned to 88.2% of prepandemic levels. The South West region stood out as having recovered activity levels to the greatest extent, with activity at 97.3% of prepandemic levels during 2022. The South West also had the highest postpandemic day-case rate at 74.9% of all patients seen as a day-case during 2022; this compares with an England average of 65.3%. At an ICB level, there was a significant correlation between day-case rates and postpandemic activity levels (r = 0.362, p = 0.019). There was no strong or consistent evidence that day-case surgery had poorer patient outcomes than inpatient surgery. Recovery of elective laparoscopic cholecystectomy activity has been better in South West England than in other regions. Increasing day-case rates may be important if ICBs in other regions are to increase activity levels up to and beyond prepandemic levels.

Comparative evaluation of blind supraglottic airway device insertion versus videolaryngoscope-guided technique in adults undergoing laparoscopic cholecystectomy

ABSTRACT Objectives A videolaryngoscope may decrease the high incidence of aberrant positioning of supraglottic airway devices (SAD) inserted with blind techniques. We aimed to compare Igel insertion characteristics between blind and videolaryngoscope-assisted techniques. Methods In this study 70 adult patients scheduled for elective laparoscopic cholecystectomy under general anesthesia were randomly divided into blind (Group B, n = 35) and videolaryngoscope-guided (Group V, n = 35) Igel insertion. Oropharyngeal leak pressure (OLP), fiber-optic view score, time for device insertion, first attempt success, ease of insertion, ventilation score, maneuvers, and adverse events were assessed. Results OLP was significantly higher in group V at 1 and 10 minutes (24.80 ± 1.91 vs 21.71 ± 2.37; p < 0.001 and 32.60 ± 2.32 vs 30.68 ± 2.93; p = 0.006). The mean fiberoptic scoring (3.63 ± 0.49 vs 3.38 ± 0.49; p = 0.043), a fibreoptic score of grade 4 (24 vs 13; p = 0.012) and time-to-device insertion (25.6 ± 3.5 vs 21.7 ± 4.1; p < 0.001) was considerably higher in group V. First-attempt success (p = 0.630), ease of insertion of SAD (p = 0.540) and nasogastric tube (p = 1), ventilation score (p = 1), number of maneuvers required (p = 1), number of attempts (p = 0.592) and postoperative complications (p = 0.800) were comparable in the two groups. Conclusion The videolaryngoscope-guided technique provided superior airway sealing and reduced malposition of Igel without an increase in adverse events compared to the blind technique. However, this was at the cost of increased time of device insertion. Clinical trial registration www.ctri.nic.in identifier is CTRI/2022/10/046269

Comparative study of elective cholecystectomy with and without antimicrobial prophylaxis: A prospective randomized study

Background: Cholecystectomy is one of the most common, clean, and contaminated surgery operations performed by surgeons worldwide. Antibiotic prophylaxis in elective cholecystectomy is a controversial issue and our study was undertaken to evaluate the rate of infection and the usefulness and efficacy of antibiotic prophylaxis in elective cholecystectomies. Aims and Objectives: The aims and objectives are to study antimicrobial prophylaxis on elective laparoscopic cholecystectomy and to compare surgical site infections (SSI) between the two groups after laparoscopic cholecystectomy with respect to (a) duration of surgery, (b) post-operative pain, (c) complications encountered, and (d) post-operative hospital stay. Materials and Methods: Patients were randomly divided into the study group (Group A) and the control group (Group B). Antibiotic dose of ceftriaxone + sulbactam 1.5 g will be administered intravenously 2 h before induction of anesthesia for the patients in the study Group A (n=30), and no antibiotic will be administered prophylactically to the control Group B (n=30). Results: In the study group, one patient developed fever, and in the control Group, 4 patients developed fever. In this study, SSIs were considered. In the study group, two patients (6.67%) developed pus discharge from the port site which was considered superficial infection, and in the control group, five patients (16.67%) developed pus discharge. Conclusion: Based on our study, in elective cholecystectomy, a single dose of intravenous ceftriaxone + salbactam 1.5 g given before the operative procedure does not lead to a higher SSI rate as compared to the conventionally given antibiotics which are continued postoperatively for a variable length of time.

COMPARISON OF THE VARIABILITY OF RECOVERY PROFILE AND HEMODYNAMIC EFFECTS OF NEUROMUSCULAR BLOCKADE WITH CISATRACURIUM VERSUS ATRACURIUM

A randomized controlled trial was conducted at the Main Operation Theatre of Jinnah Postgraduate Medical Centre (JPMC) in Karachi to compare the recovery profile and hemodynamic effects of cisatracurium and atracurium among patients undergoing laparoscopic cholecystectomy. The study was conducted from 20th July 2019 to 19th January 2020 and included 68 patients aged between 20 to 50 years undergoing elective laparoscopic cholecystectomy under general anesthesia. Patients with a history of allergy to the study drugs, neuromuscular, pulmonary, renal, or hepatic diseases, smoking, pregnancy, or breastfeeding, and those on preoperative medication such as antipsychotics, aminoglycosides, steroids, or neuroleptics were excluded. The patients were randomly divided into two groups. In Group 1, comprising 34 patients, cisatracurium (0.2 mg/kg) was administered, whereas in Group 2, also with 34 patients, atracurium (0.5 mg/kg) was given. Neuromuscular blocking agents were administered three minutes before intubation. The primary outcomes measured were the recovery profile and hemodynamic effects. In Group 1 (cisatracurium), the baseline mean arterial pressure (MAP) was recorded as 98.40 ± 8.02 mmHg, which increased to 112.20 ± 8.88 mmHg before intubation, resulting in a change of 13.56 ± 5.59 mmHg. In contrast, in Group 2 (atracurium), the baseline MAP was 94.10 ± 7.91 mmHg, which rose to 109.07 ± 8.35 mmHg before intubation, indicating a change of 16.50 ± 4.38 mmHg. The study concluded that cisatracurium is more effective in exhibiting neuromuscular blocking properties than atracurium in patients undergoing laparoscopic cholecystectomy under general anesthesia.

Repair of umbilical hernias concomitant to other procedures is safe: a propensity score-matched database study.

Repair of an umbilical hernia is most often considered the less important condition when concomitant with other abdominal surgery. Despite this, the evidence for a concomitant umbilical hernia repair is sparse. The aim of this nationwide cohort study is to compare the short- and long-term outcomes of primary umbilical hernia repair and umbilical hernia repair concomitant with other abdominal surgery. Data from the Danish Hernia Database and the National Patients Registry from January 2007 to December 2018 was merged, resulting in identification of patients receiving umbilical hernia concomitant to another abdominal surgery (laparoscopic inguinal hernia repair, laparoscopic cholecystectomy, and laparoscopic appendectomy). This group was propensity score matched with patients undergoing umbilical hernia repair as a primary procedure. Outcome data included 90-day readmission, 90-day reoperation, and operation for recurrence. A total of 3365 primary umbilical hernia repairs and 2418 umbilical hernia repairs concomitant to other abdominal surgery were included. Readmission (10.5%, 255/2418) and reoperation (3.8%, 93/2418) rates within 90 days were decreased for umbilical hernia repairs concomitant to other abdominal surgery, compared with primary umbilical hernia repairs (22.7%, 765/3365) and (10.5%, 255/3365), P<0.001 and P<0.001, respectively. The rate of operation for recurrence was significantly increased for primary repairs (4.2%, 141/3365), compared with repairs concomitant to other abdominal surgery (3.2%, 77/2418), P=0.014. Outcome in umbilical hernia repair performed concomitant to laparoscopic inguinal hernia repair, elective or emergency laparoscopic cholecystectomy, or laparoscopic appendectomy is comparable to umbilical hernia repair without concomitant surgery.

Comparative Study between Bilateral and Unilateral Erector Spinae Plane Block in Managing Postoperative Pain in Laparoscopic Cholecystectomy

Background: Postoperative pain after laparoscopic cholecystectomy remains as an important problem, with two components: somatic and visceral. Surgical incisions lead to somatic pain, while abdominal inflation and diaphragm irritation leads to visceral pain. Erector spinae plane block is a newly described interfascial plane block. Aim: to compare bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy Patients and Methods: The study involved 50 patients scheduled for elective laparoscopic cholecystectomy. Patients were randomly assigned in to two equal groups each with 25 patients: unilateral and bilateral erector spinae plane block. Numerical Pain score and need for analgesia during all time points to 12 hr post recovery; hemodynamic indices at baseline, during all time poins from full recovery to 12 hr post recovery were recored. Results: there were no significant differences between the two groups in hemodynamic indices. At 12thhr post operation, 36%, 12% and 36% of patients in unilateral group demonstrated mild, moderate and required rescue analgesia, respectively compared with 28%, 8% and 20% of patients in bilateral group with a statistically significant difference. at 3rdhr post operation, 12% and 8% of patients in unilateral group need paracetamol and tramal, respectively, compared 4% and 0%, respectively in bilateral group, with a significant difference. Additionally, at 12thhr post operation, 34% and 12% of patients in unilateral group need paracetamol and tramal, respectively, compared 28% and 8%, respectively in bilateral group, with a significant difference. Conclusions: Unilateral and bilateral erector spinae plane block seem to have no serious impact hemodynamic indices. Bilateral block is associated with lower pain score and need for postoperative analgesia than unilateral block

Impact of Dexmedetomidine on Postoperative Nausea and Vomiting in Opiate-Addicted Patients Undergoing Elective Laparoscopic Cholecystectomy: A Randomized, Placebo-Controlled Clinical Trial

Background: Postoperative Nausea and Vomiting (PONV) is one of the most common complications of general anesthesia, moreover opioid addiction increases the risk of PONV. Hence, this study evaluates the effect of administering dexmedetomidine infusion as an intraoperative analgesic on PONV in opium-addicted patients who underwent elective laparoscopic cholecystectomy.&#x0D; Methods: In a randomized clinical trial, 100 opium-addicted patients who were candidates for elective laparoscopic cholecystectomy surgery under general anesthesia were studied in two groups of 50 participants. The intervention group received dexmedetomidine infusion 10 min after induction of anesthesia until the end of surgery. The placebo group received normal saline at the same time. The rate of PONV was compared between the two groups.&#x0D; Results: Both groups had no significant difference in terms of hemodynamic parameters during surgery, including pulse rate, systolic and diastolic blood pressure, and duration of anesthesia. In the dexmedetomidine group, patients had less PONV than the control group, and this difference was significant (p=0.0164).&#x0D; Conclusion: Dexmedetomidine administration during laparoscopic surgery can reduce PONV, especially in patients addicted to opium.&#x0D;  

Use of artificial intelligence in the detection of the critical view of safety during laparoscopic cholecystectomy

Purposeto evaluate the use of artificial intelligence to detect the critical view of safety during elective laparoscopic cholecystectomy. Methodsprospective, observational study evaluating the detection of the critical view of safety with an artificial intelligence software in a consecutive series of elective laparoscopic cholecystectomies, compared to the blinded evaluation of 3 surgeons. The program was created using the digital tools PyCharm, Google Colab Pro and Ultralytics YOLO v8. Results40 consecutive elective laparoscopic cholecystectomies were included in the study. The program was able to detect the critical view of safety in all cases, in accordance to the experts blinded opinion. Conclusionin this preliminary experience, an artificial intelligence software was able to detect the critical view of safety in elective laparoscopic cholecystectomies. Its application during non elective cases, where the critical view of safety is harder to achieve, might warrant further studies.

Association between patient activation and delayed discharge in elective laparoscopic cholecystectomy: A prospective cohort analysis

BackgroundImproving patient activation may be an effective way to reduce healthcare costs and improve patient outcomes after surgery. ObjectiveTo determine whether preoperative patient activation is associated with delayed discharge (ie, length of stay >24 h) after elective laparoscopic cholecystectomy. Postoperative symptoms, unscheduled access to healthcare facilities within seven days of surgery, unplanned hospital readmissions, and postoperative complications were analyzed as secondary outcome. DesignThis cohort study was a secondary analysis of DeDiLaCo study (Delayed Discharge after day-surgery Laparoscopic Cholecystectomy) collecting data of patients undergoing elective laparoscopic cholecystectomy during 2021 in Italy. Data was analyzed from June 2022, to April 2023. Setting90 Italian surgical centers participating in the Study. Participants4708 adult patients with an instrumental diagnosis of gallbladder disease and undergoing laparoscopic cholecystectomy. Patient activation was assessed using the Italian translation of Patient Activation Measure in the preoperative setting. ResultsOf 4532 cases analyzed the median (IQR) Patient Activation Measure Score was 80.3 (71.2–92.3). Participants were on average 55.5 years of age and 58.1 % were female. Two groups based on activation level were created: 270(6 %) had low activation, and 4262 had high activation. Low activation level was associated with the likelihood of delayed discharge (odds ratio [OR]1.47, 95 % CI, 1.11–1.95; P = .008), higher symptom burden (OR 1.99, 95 % CI 1.49–2.66, P < .0001), unplanned healthcare utilization within seven days after hospital discharge (OR 1.85, 95 % CI, 1.29–2.63; P = .001). There was no difference between the high and low activation groups in the incidence of postoperative complications (OR 1.28, 95 % CI, 0.95–1.73; P = .10) and hospital readmission after discharge (OR 0.95, 95 % CI, 0.30–3.05; P = .93). ConclusionsOur results suggest that patients with low activation have 1.47 times the risk of delayed discharge compared with patients with higher activation, almost twice the risk of the onset of postoperative symptoms, and 1.85 the risk of unscheduled use of hospital services. Screening for patient activation in the preoperative setting could not only identify patients not suitable for early discharge, but more importantly, help physicians and nurses develop tailored interventions.

Effect of preoperative oral carbohydrates on insulin resistance in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial

PurposeThe present research seeks to clarify the consequences of two specific preoperative oral carbohydrate (POC) amounts on insulin resistance (IR) and stomach evacuation in laparoscopic cholecystectomy (LC) patients.MethodsA total of 129 patients set for elective LC procedures were randomly assigned to a control group (C, n = 45), a 200 mL POC group (P1, n = 42), and a 400 mL POC group (P2, n = 42). The C group was fasted from midnight until surgery, whereas the P1 and P2 groups received their respective carbohydrate volumes 2–4 h before anesthesia. Fasting blood glucose, insulin, and glucagon concentrations were measured at three junctures. IR metrics were derived by employing the homeostasis model assessment. Gastric volume was measured before anesthesia using gastric ultrasound. Inter-group comparisons included IR indicators, subjective comfort scores, and hemodynamic data.ResultsAt T2, the C group exhibited reduced glucose concentrations compared to the P2 group (4.73 ± 0.64 vs. 5.26 ± 1.02 mmol/L, p < 0.05). The Perlas grading indicated that grade 1 was more prevalent in the P2 group than in the P1 and C groups (18 [42.9%] vs. 6 [14.3%] and 1 [2.2%], p < 0.05). Additionally, thirst and hunger metrics for the P2 group were notably reduced compared to the C group at both T2 and T3.ConclusionAdministering either 200 mL or 400 mL of carbohydrates 2–4 h pre-surgery had no detectable impact on IR or gastric volume in LC patients.Trial registrationChiCTR, ChiCTR2200065648. Registered January 13, 2023, http://www.chictr.org.cn.

Keep it simple: a crosshair on the screen during proctored laparoscopic surgeries.

Inside the operating room, experts use verbal instructions to guide surgical novices through laparoscopic procedures. In this study, we evaluated the use of a crosshair attached to the video monitor, as a hands-free pointing tool to simplify instructions during operation. Ten surgical novices performed two elective laparoscopic cholecystectomies within a week of each other, randomized such that one was performed with and the other without using the crosshair. Directly after operation, questionnaires were completed by the novices and the consultant surgeons. Measures including the comprehensibility of instructions, subjective feeling of safety during preparation, time delays due to different instruction options, and disruptive influence while instructors used the crosshair. Differences in operative performance were evaluated based on the global operative assessment of laparoscopic skills (GOALS) scores. When the crosshair was used, surgical novices had a better understanding of which anatomical structure should be shown (p = 0.028). Operating time (p = 0.222) and feeling of confidence during preparation did not differ with versus without crosshair use (p = 0.081). All participants stated that the crosshair did not negatively affect the field of vision. In terms of the median GOALS score, the operative performance was improved when the crosshair was used compared with verbal instructions only (median 15, IQR (11; 21) vs. median 12, IQR (5; 19), p < 0.001). The crosshair is a simple, inexpensive, and widely available method to improve communication between instructors and novices in everyday training.

Outcomes of Percutaneous Image-Guided and Laparoscopic Cholecystostomies in High-Risk Patients With Acute Calculus Cholecystitis: A Five-Year District General Hospital Experience.

Introduction Acute cholecystitis (AC), inflammation of the gall bladder, is one of the most common emergency surgical presentations. In the UK, approximately 15% of the population is estimated to have gallstones, and approximately 20% of them can develop AC. Laparoscopic cholecystectomy (LC) is considered the definitive management of AC. However, cholecystectomy carries a very high risk of morbidity and mortality in high-risk frail patients with multiple comorbidities who are deemed unfit for surgery. Percutaneous cholecystostomy (PC), both image-guided and laparoscopic, is generally acknowledged as an interim treatment measure before definitive management, which is the LC. Materials and methods This is a retrospective study from the Royal Albert Edward Infirmary, a district general hospital (DGH) based in Wigan, UK. The medical records of all the patients whowere admitted to the surgical department and underwent PC between January 2017 and December 2022 were analyzed. Patients with previous hepato-pancreato-biliary (HPB) malignancy, who underwent open cholecystostomy, or those withabdominal ascites were excluded from the study. Information was collected regarding the age, gender, American Society of Anaesthesiologists(ASA) grades, success rates of both procedures as temporary or definitive management, duration of hospital stay, 30-day and 1-year mortality after the procedure, timing of the procedure,and long-term complications after the procedure, particularly those related to cholecystostomy tube dislodgment or blockage. Results Twenty-seven patients who underwent PCwere divided into two groups: group A, consisting of 10 patients who underwent laparoscopic cholecystostomies, and group B, consisting of 17 patients who had ultrasound (US)-guided cholecystostomies.The mean age of the patients in group A was 66.7 as compared to 75.1 in group B.Most of the patients were in ASAgroups III (14) and IV (10). About 74% of patients had procedures done during the day and 26% had PC at night time. The mean hospital stay was 13.5 days. About 55% of patients had planned elective LC as a definitive management. Following the treatment, two patients died within 30 days, and eight patients passed away within a year. About 40% of the patients had complications related to the tube dislodgment and blockage. Conclusion This study concludesthat PC, using both laparoscopic and US-guided techniques, can serve as an interim as well as a definitive measure,particularly in patients who are at high risk for anesthesia and the procedure itself and have multiple comorbidities.