Gelmini Roberta, Franzoni Chiara, Saviano Massimo
Ann Ital Chir. 2013 Nov-Dec;84(6):631-6.
Analyze the results of an early experience in day-case LC (laparoscopic cholecystectomy) in a single laparoscopic unit, in terms of clinical outcome, unexpected admissions, readmissions, patients satisfaction.
During three years, 200 consecutive patients underwent LC. Emergency procedures (32pts) and patients scheduled for cholecystectomy plus other surgical procedures (21pts) were excluded. Thus, 147 patients underwent elective LC and 43 were scheduled for DSLC (day-surgery laparoscopic cholecystectomy).
Six patients (13,9%) were considered not eligible for a same day discharge and admitted to the inpatients ward for overnight observation. The re-admission rate was 2,3% and 41 patients (95.3%) were completely satisfied.
Patients satisfaction was complete in 95.3% of cases, related to a correct preoperative information and the reduction in hospital costs amounted approximately to 41%. Despite the evidence of feasibility and safety of the daycase procedure, the Italian cultural background is nowadays inadequate for a clean acceptance of the DSLC. The provision of adequate staff education and training prior to full DSLC introduction is mandatory to the success of this organizational model.
LC can be performed safely in an outpatient setting if there's a careful education of patients and the surgical and anesthesiologist team is well-trained. Besides, good results can be achieved considering inclusion criteria. For the admission to be kept to a minimum, postoperative pain and nausea management has to be carefully planned such as discharge criteria evaluated. For selected patients, day-case LC is feasible and safe and can provide a reduction in hospital costs.
