Department of General Surgery, Doncaster Royal Infirmary, Doncaster and Bassetlaw NHS Foundation Trust, Armthorpe Road, Doncaster, DN25LT, UK.
, 3a Boswell Drive, Coventry, CV2 2DL, UK.
Surg Endosc. 2017 Sep;31(9):3534-3538. doi: 10.1007/s00464-016-5380-1. Epub 2016 Dec 23.
Laparoscopic cholecystectomy is the gold standard for the treatment of symptomatic gallstones and its practice as day case where possible is considered the standard over the last decade. However, readmission after surgery is recognised as a new problem.
The aim of this cohort observational study was to investigate the readmission rate in a district general hospital and identify the causes of readmission in order to explore ways by which this can be reduced or managed more cost effectively.
Records of patients who had laparoscopic cholecystectomy over 6 months were retrospectively searched. Patients returning to hospital due to symptoms within 30 days of elective and emergency laparoscopic cholecystectomy were included.
Three hundred and twenty-eight laparoscopic cholecystectomies were performed within the 6-month period. Twenty-two patients returned within 30 days of surgery making a readmission rate of 6.7%. Reasons for inpatient admission were abdominal pain without any underlying cause 10 (45.5%), wound infection 5 (22.7%), leg swelling 2 (9%), retained stone 1 (4.5%), bile leak 1 (4.5%), pneumonia 1 (4.5%), iatrogenic bowel injury 1 (4.5%) and back pain 1 (4.5%). Readmission rate decreased with longer duration of stay in hospital during primary admission, and 64% of patients returned to the hospital within 7 days of procedure. 50% of patients who returned with abdominal pain without any identifiable cause had a longstanding history of conditions involving chronic pain.
While the feared intra-abdominal complications of cholecystectomy often come to mind when assessing patients presenting with abdominal pain after surgery, non-specific abdominal pain is consistently shown to be several times more likely. A combination of patient factors and pain control techniques account for this pain. Effective multimodal pain management approach and community primary health care support in the early post-operative period could reduce readmission, save cost and improve patient experience.
腹腔镜胆囊切除术是治疗有症状胆囊结石的金标准，在过去十年中，尽可能将其作为日间手术进行治疗被认为是标准。然而，手术后的再次入院已被认为是一个新的问题。
本队列观察性研究的目的是调查一家地区综合医院的再入院率，并确定再入院的原因，以探讨降低或更具成本效益地管理这种情况的方法。
回顾性搜索了在 6 个月内接受腹腔镜胆囊切除术的患者记录。将因择期和急诊腹腔镜胆囊切除术后 30 天内出现症状而返回医院的患者纳入研究。
在 6 个月期间共进行了 328 例腹腔镜胆囊切除术。22 例患者在手术后 30 天内再次入院，再入院率为 6.7%。住院的原因是腹痛而无明确病因 10 例（45.5%）、伤口感染 5 例（22.7%）、腿部肿胀 2 例（9%）、残留结石 1 例（4.5%）、胆漏 1 例（4.5%）、肺炎 1 例（4.5%）、医源性肠损伤 1 例（4.5%）和背痛 1 例（4.5%）。初次住院时住院时间延长，再入院率降低，64%的患者在手术后 7 天内返回医院。64%返回医院的腹痛患者没有明确病因，且他们有长期的慢性疼痛相关病史。
在评估手术后出现腹痛的患者时，虽然常常会考虑胆囊切除术的腹部内并发症，但非特异性腹痛更常见。患者因素和疼痛控制技术的综合作用导致了这种疼痛。在术后早期采用有效的多模式疼痛管理方法和社区初级保健支持，可以降低再入院率，节省成本并改善患者体验。
