Department of General Surgery, Mount Gambier General Hospital, P.O. Box 267, Mount Gambier, SA, Australia.
Langenbecks Arch Surg. 2010 Mar;395(3):255-60. doi: 10.1007/s00423-009-0569-6. Epub 2009 Nov 25.
Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstone disease. Cultural as well as organisational differences can result in significant variations of postoperative length of stay. AIM OF THE PRESENT STUDY: The aim of this study is to evaluate whether differences in postoperative length of stay and early postoperative outcome can be observed by comparison of an Australian rural centre and a German university hospital.
Between February 2006 and August 2007 (18 months), 359 patients (140 Australia, 219 Germany) underwent laparoscopic cholecystectomy. Mean patient age was 50.4 +/- 1.5 and 53.5 +/- 1.0 years, respectively. Seventy-seven percent of the Australian and 62% of the German patients were female. Twenty-one percent and 20% of the procedures were emergencies, respectively. Median American Society of Anaesthesiologists score of all patients was two. The conversion rate was 8% in both centres. A 4% complication rate was observed in Australia (N = 5, 3x bile leak, 1x postoperative bleeding and 1x wound infection) as opposed to 3% in Germany (N = 7, 2x bile leak, 2x postoperative bleeding and 3x wound infection). Postoperative length of stay in Australia was 1.8 +/- 0.1 days (median 1 day) and was significantly longer in patients after emergency surgery (1.6 +/- 0.1 versus 2.6 +/- 0.3 days, p < 0.018). Postoperative length of stay in Germany was 3.7 +/- 0.2 days (median 3 days), and no significant differences were observed when elective and emergency procedures were compared (3.5 +/- 0.2 versus 3.9 +/- 0.5 days, p > 0.05). Comparison of treatment results indicates a significantly shorter postoperative stay in Australia (3 days versus 1 day, p < 0.001).
DISCUSSION/CONCLUSION: In rural Australia, a median postoperative stay of 1 day after laparoscopic cholecystectomy can be safely achieved. Postoperative length of stay is significantly longer in the German setting with otherwise comparable patients and surgical techniques. Simple changes of pre- and postoperative management of elective as well as emergency laparoscopic cholecystectomy will allow, for substantial cost savings, for the German health system.
腹腔镜胆囊切除术是治疗有症状的胆囊疾病的首选方法。文化和组织上的差异可能导致术后住院时间的显著差异。本研究的目的：本研究的目的是通过比较澳大利亚农村中心和德国大学医院，评估术后住院时间和早期术后结果是否存在差异。
2006 年 2 月至 2007 年 8 月（18 个月），359 例患者（澳大利亚 140 例，德国 219 例）行腹腔镜胆囊切除术。患者平均年龄分别为 50.4±1.5 岁和 53.5±1.0 岁。77%的澳大利亚患者和 62%的德国患者为女性。分别有 21%和 20%的手术为急症。所有患者的美国麻醉医师协会评分中位数为 2 分。转换率在两个中心均为 8%。澳大利亚并发症发生率为 4%（N=5，3 例胆漏，1 例术后出血，1 例伤口感染），德国为 3%（N=7，2 例胆漏，2 例术后出血，3 例伤口感染）。澳大利亚术后住院时间为 1.8±0.1 天（中位数 1 天），急症手术后明显延长（1.6±0.1 天与 2.6±0.3 天，p<0.018）。德国术后住院时间为 3.7±0.2 天（中位数 3 天），急症和择期手术比较无显著差异（3.5±0.2 天与 3.9±0.5 天，p>0.05）。治疗结果比较表明，澳大利亚术后住院时间明显缩短（3 天与 1 天，p<0.001）。
讨论/结论：在澳大利亚农村，腹腔镜胆囊切除术后 1 天的中位住院时间是安全的。德国的术后住院时间明显延长，患者和手术技术相似。对择期和急症腹腔镜胆囊切除术的术前和术后管理进行简单的改变，将为德国卫生系统节省大量成本。
