Bardram Linda, Klarskov Birthe, Rosenberg Jacob, Lund Claus M, Kehlet Henrik
Kirurgisk Sektion, Gastroenheden, H:S Hvidovre Hospital, DK-2650 Hvidovre.
Ugeskr Laeger. 2005 Jun 13;167(24):2644-8.
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.
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.
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%.
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.
通过精心挑选患者和外科医生，高达90%的择期手术患者可接受门诊腹腔镜胆囊切除术。然而，在未经过筛选而安排择期手术的患者群体中，当日出院率尚不清楚。
引入门诊腹腔镜胆囊切除术临床路径作为所有接受择期手术患者的标准程序。该设置允许在需要时方便地安排过夜住院。分析了住院时间、并发症、入院原因、出院后所需医疗建议、康复情况及患者满意度。在标准护理计划中进行前瞻性登记，并在四周后发送问卷调查。
在研究的两年期间，535例患者接受了胆囊切除术。其中，403例安排进行择期腹腔镜手术并进入临床路径。62%的患者成功完成门诊疗程，94%的患者在24小时内出院。2%的患者因并发症导致住院时间超过三天，2.7%的手术转为开腹手术。约三分之一的患者出院后需要额外的医疗建议，其中4.3%再次入院。疼痛是最常见的主诉之一。患者对该手术的满意度约为90%。
在未经过筛选而安排择期腹腔镜胆囊切除术的患者群体中，约三分之二的患者可作为门诊患者接受治疗，具有较高的安全性和患者满意度。为了减少术后不适并改善康复过程，进一步发展，尤其是在疼痛的多模式治疗方面，仍然是最重要的关注领域。
