Department of General Surgery, Midland Regional Hospital, Mullingar, Westmeath, Ireland.
Royal College of Surgeons, Dublin, Ireland.
HPB (Oxford). 2021 Feb;23(2):161-172. doi: 10.1016/j.hpb.2020.08.012. Epub 2020 Sep 6.
Laparoscopic cholecystectomy is a safe ambulatory procedure in appropriately selected patients; however, day case rates remain low. The objective of this systematic review and meta-analysis was to identify interventions which are effective in reducing the length of stay (LOS) or improving the day case rate for elective laparoscopic cholecystectomy.
Comparative English-language studies describing perioperative interventions applicable to elective laparoscopic cholecystectomy in adult patients and their impact on LOS or day case rate were included.
Quantitative data were available for meta-analysis from 80 studies of 10,615 patients. There were an additional 17 studies included for systematic review. The included studies evaluated 14 peri-operative interventions. Implementation of a formal day case care pathway was associated with a significantly shorter LOS (MD = 24.9 h, 95% CI, 18.7-31.2, p < 0.001) and an improved day case rate (OR = 3.5; 95% CI, 1.5-8.1, p = 0.005). Use of non-steroidal anti-inflammatories, dexamethasone and prophylactic antibiotics were associated with smaller reductions in LOS.
Care pathway implementation demonstrated a significant impact on LOS and day case rates. A limited effect was noted for smaller independent interventions. In order to achieve optimal day case targets, a greater understanding of the effective elements of a care pathway and local barriers to implementation is required.
腹腔镜胆囊切除术在适当选择的患者中是一种安全的门诊手术；然而，日间手术率仍然较低。本系统评价和荟萃分析的目的是确定可有效缩短住院时间（LOS）或提高择期腹腔镜胆囊切除术日间手术率的干预措施。
纳入描述适用于成年择期腹腔镜胆囊切除术的围手术期干预措施及其对 LOS 或日间手术率影响的英文比较研究。
对 10615 例患者的 80 项研究进行了定量数据分析。还纳入了 17 项研究进行系统综述。所纳入的研究评估了 14 项围手术期干预措施。实施正式的日间手术护理路径与 LOS 显著缩短（MD=24.9 小时，95%CI，18.7-31.2，p<0.001）和日间手术率提高相关（OR=3.5；95%CI，1.5-8.1，p=0.005）。使用非甾体抗炎药、地塞米松和预防性抗生素与 LOS 减少幅度较小相关。
护理路径的实施对 LOS 和日间手术率有显著影响。较小的独立干预措施的效果有限。为了实现最佳的日间手术目标，需要更好地了解护理路径的有效要素和实施的本地障碍。
