Tebala Giovanni Domenico, Belvedere Angela, Keane Sean, Khan Abdul Qayyum, Osman Abdelsalam
Gastrointestinal Surgery Unit, Colorectal Team, Division of Surgery, Noble's Hospital, Strang, Douglas, Isle of Man, IM4 4RJ, UK.
Updates Surg. 2017 Dec;69(4):461-469. doi: 10.1007/s13304-017-0433-0. Epub 2017 Mar 21.
Despite a number of studies have already demonstrated that majority of patients can be safely discharged early after laparoscopic cholecystectomy, this approach did not gain widespread diffusion yet. The present study was set up to assess safety and feasibility of 24 h or same-day discharge after laparoscopic cholecystectomy and to identify the prognostic factors. Perioperative variables of 229 patients undergoing cholecystectomy have been analyzed. Primary endpoints were: postoperative length of stay, rate of patients discharged within 24 h, and rate of those discharged on the same day. Secondary endpoints were rate of 30-day readmission and rate of 30-day postoperative complications. Two-hundred twenty-three cases have been started by laparoscopy. Conversion rate was 3.1%. Overall mean postoperative stay was 1.8 ± 3.5 days (median 1 day). Seventy-eight percent of patients have been discharged within 24 h, and 22.3% have been discharged on the same day. Postoperative morbidity was 2.2%. Readmission rate was 3.9%. At univariate analysis, factors related to early discharge were age (more or less than 65), diagnosis (simple symptomatic gallstones vs complicated gallstones), ASA score, timing of operation (elective vs emergency), history of CBD stones, laparoscopic operation, and use of drain. No single factor was significantly related to readmission rate, but the use of drains in laparoscopic cases. At multivariate analysis, only elective operation, simple symptomatic gallstones, no history of CBD stones, laparoscopic approach, and no abdominal drain resulted independently associated with discharge within 24 h from the operation. The predictive models are all fit and significant. Early postoperative discharge within 24 h should be considered in all patients with simple symptomatic gallstones who had laparoscopic cholecystectomy. Same-day discharge should be considered if no drain was left at the end of the operation.
尽管多项研究已表明，大多数患者在腹腔镜胆囊切除术后可安全地提前出院，但这种方法尚未得到广泛应用。本研究旨在评估腹腔镜胆囊切除术后24小时或当日出院的安全性和可行性，并确定预后因素。分析了229例行胆囊切除术患者的围手术期变量。主要终点为：术后住院时间、24小时内出院患者比例以及当日出院患者比例。次要终点为30天再入院率和术后30天并发症发生率。223例手术通过腹腔镜开始。中转率为3.1%。术后总体平均住院时间为1.8±3.5天（中位数1天）。78%的患者在24小时内出院，22.3%的患者当日出院。术后发病率为2.2%。再入院率为3.9%。单因素分析显示，与早期出院相关的因素有年龄（65岁以上或以下）、诊断（单纯症状性胆结石与复杂性胆结石）、美国麻醉医师协会（ASA）评分、手术时机（择期与急诊）、胆总管结石病史、腹腔镜手术以及引流管的使用。没有单一因素与再入院率显著相关，但腹腔镜手术中引流管的使用除外。多因素分析显示，只有择期手术、单纯症状性胆结石、无胆总管结石病史、腹腔镜手术方式以及未放置腹腔引流管与术后24小时内出院独立相关。预测模型均拟合良好且具有显著性。所有行腹腔镜胆囊切除术的单纯症状性胆结石患者均应考虑术后24小时内早期出院。如果手术结束时未留置引流管，则应考虑当日出院。
