Pham Helen, Chiong Corinna, Sinclair Jane-Louise, Pang Tony C Y, Yuen Lawrence, Lam Vincent W T, Pleass Henry C, Johnston Emma, Richardson Arthur J, Hollands Michael J
Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia.
Western Clinical School, The University of Sydney Faculty of Medical and Health Sciences, Sydney, New South Wales, Australia.
ANZ J Surg. 2021 Apr;91(4):590-596. doi: 10.1111/ans.16526. Epub 2020 Dec 28.
Day-only laparoscopic cholecystectomy (DOLC) has been shown to be safe and feasible yet has not been widely implemented in Australia. This study explores the introduction of routine DOLC to Westmead Hospital, and highlights the barriers to its implementation.
Routine day-only cholecystectomy protocol was introduced at Westmead Hospital in 2014. A retrospective review of patients who underwent elective laparoscopic cholecystectomy during a 12-month period in 2014 was compared to a 12-month period in 2018, to examine the changes in practice after implementation of a unit protocol. Data were collected on patient demographics, admission category, outcomes and re-presentations.
A total of 282 patients were included in the study, of these 169 were booked as day procedures, with 124 (73%) successfully discharged on the same day. There was a significant increase in the proportion of patients booked as day-only from 2014 to 2018 (48% versus 73%, P < 0.001). Day-only failure rates (unplanned overnight admissions), readmissions and complication rates were comparable between the two periods. The most common reason for unplanned overnight admissions were due to intraoperative findings (n = 28/45).
Routine DOLC can be adopted in Australian hospitals without compromise to patient safety. Unplanned overnight admission is predominantly due to unexpected surgical pathology and can be reduced by protocols for the use of drains and planned outpatient endoscopic retrograde cholangiopancreatography. Unplanned outpatient review can be minimized by optimizing both intra- and post-operative pain management. Individual surgeon and anaesthetist preferences remain an obstacle to a standardized protocol in the Australian setting.
日间腹腔镜胆囊切除术（DOLC）已被证明是安全可行的，但在澳大利亚尚未得到广泛实施。本研究探讨了在韦斯特米德医院引入常规DOLC的情况，并强调了其实施过程中的障碍。
2014年在韦斯特米德医院引入了常规日间胆囊切除术方案。将2014年12个月期间接受择期腹腔镜胆囊切除术的患者回顾性数据与2018年12个月期间的数据进行比较，以检查实施科室方案后的实践变化。收集了患者人口统计学、入院类别、结局和再次就诊的数据。
该研究共纳入282例患者，其中169例被安排为日间手术，124例（73%）在同一天成功出院。从2014年到2018年，被安排为仅日间手术的患者比例显著增加（48%对73%，P<0.001）。两个时期的日间手术失败率（计划外过夜住院）、再入院率和并发症发生率相当。计划外过夜住院的最常见原因是术中发现（n=28/45）。
澳大利亚医院可以采用常规DOLC，而不会危及患者安全。计划外过夜住院主要是由于意外的手术病理情况，可以通过引流管使用方案和计划性门诊内镜逆行胰胆管造影术来降低。通过优化术中及术后疼痛管理，可以将计划外门诊复查降至最低。在澳大利亚的环境中，个别外科医生和麻醉师的偏好仍然是标准化方案的一个障碍。
