PubMed2005
INTRODUCTION: By careful selection of both patients and surgeon, outpatient laparoscopic cholecystectomy can be performed in up to 90% of elective patients. The rate of same-day discharge in an unselected group scheduled for elective operation is, however, not clarified. MATERIALS AND METHODS: A clinical pathway for outpatient laparoscopic cholecystectomy was introduced as the standard procedure for all patients undergoing elective operation. The set-up allowed easy access to an overnight stay if needed. Hospital stay, complications, reasons for admittance, the need for medical advice after discharge, convalescence and patients" satisfaction were analysed. Prospective registrations were undertaken in a standard care plan, and a questionnaire was sent out after four weeks. RESULTS: During two years of the study, 535 patients had a cholecystectomy done. Of these, 403 were scheduled for elective laparoscopic operation and entered the clinical pathway. In 62% of the patients, the outpatient course was successfully completed, and 94% of the patients were discharged within 24 hours. In 2%, complications resulted in hospital stays longer than three days, and 2.7% of the operations were converted. About one third of the patients needed additional medical advice after discharge, and 4.3% of these were readmitted. Pain was among the most frequent complaints. The patients" satisfaction with the procedure was approximately 90%. DISCUSSION: In an unselected group of patients scheduled for elective laparoscopic cholecystectomy, about two thirds can be treated as outpatients with a high degree of safety and patients" satisfaction. Further development, especially in the multimodal treatment of pain, is still the most important area to focus on in order to reduce postoperative complaints and improve the course of convalescence.