Department of General and Digestive Surgery, La Ribera University Hospital, Alzira, Valencia, Spain.
Department of Gynecology and Obstetrics, La Fe University Hospital, Valencia, Spain.
Surgery. 2021 Aug;170(2):373-382. doi: 10.1016/j.surg.2020.12.029. Epub 2021 Feb 6.
Outpatient laparoscopic cholecystectomy has proven to be a safe and cost-effective technique; however, it is not yet a universally widespread procedure. The aim of the study was to determine the predictive factors of outpatient laparoscopic cholecystectomy failure.
A systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis methodology. MEDLINE, Cochrane Library, Ovid, and ISRCTN Registry were searched. The main variables were demographic (age, sex), clinical (weight, American Society of Anesthesiologists classification, previous complicated biliary pathology, history of abdominal surgery in supramesocolic compartment, gallbladder wall thickness), and surgical factors (operative time, afternoon surgery). The secondary variables were the prevalence rates of outpatient laparoscopic cholecystectomy failure due to pain or postoperative nausea and vomiting.
Fourteen studies (4,194 patients) were included, with a mean outpatient laparoscopic cholecystectomy failure rate of 23.4%. The predictors of outpatient laparoscopic cholecystectomy failure were: age ≥65 years (odds ratio: 2.34; 95% confidence interval, 1.42-3.86; P = .0009), body mass index ≥30 (odds ratio: 1.6; 95% confidence interval, 1.05-2.45; P = .03), American Society of Anesthesiologists score ≥III (odds ratio: 2.89; 95% confidence interval, 1.72-4.87; P < .0001), previous complicated biliary pathology (odds ratio: 2.39; 95% confidence interval, 1.40-4.06; P = .001), gallbladder wall thickening (odds ratio: 2.33; 95% confidence interval, 1.34-4.04; P = .003), surgical time exceeding 60 minutes (mean difference: -16.03; 95% confidence interval,-21.25 to -10.81; P < .00001), and the beginning of surgery after 1:00 pm (odds ratio: 4.20; 95% confidence interval, 1.97-11.96; P = .007). Sex (odds ratio: 1.07; 95% confidence interval, 0.73-1.57, P = .73) and history of abdominal surgery in the supramesocolic compartment (odds ratio: 2.32; 95 confidence interval, 0.92-5.82, P = .07) were not associated with outpatient laparoscopic cholecystectomy failure.
Our meta-analysis allowed us to identify the predictors of outpatient laparoscopic cholecystectomy failure. The knowledge of these factors could help surgeons in their decision-making process for the selection of patients who are suitable for outpatient laparoscopic cholecystectomy.
门诊腹腔镜胆囊切除术已被证明是一种安全且具有成本效益的技术，但尚未广泛普及。本研究旨在确定门诊腹腔镜胆囊切除术失败的预测因素。
根据系统评价和荟萃分析的首选报告项目进行系统评价和荟萃分析。检索了 MEDLINE、Cochrane 图书馆、Ovid 和 ISRCTN 注册处。主要变量为人口统计学（年龄、性别）、临床（体重、美国麻醉医师协会分类、既往复杂胆道病变、上腹部手术史、胆囊壁厚度）和手术因素（手术时间、下午手术）。次要变量为因疼痛或术后恶心呕吐而导致门诊腹腔镜胆囊切除术失败的发生率。
纳入了 14 项研究（4194 例患者），门诊腹腔镜胆囊切除术失败的平均发生率为 23.4%。门诊腹腔镜胆囊切除术失败的预测因素包括：年龄≥65 岁（比值比：2.34；95%置信区间，1.42-3.86；P=0.0009）、体质指数≥30（比值比：1.6；95%置信区间，1.05-2.45；P=0.03）、美国麻醉医师协会评分≥III 级（比值比：2.89；95%置信区间，1.72-4.87；P<0.0001）、既往复杂胆道病变（比值比：2.39；95%置信区间，1.40-4.06；P=0.001）、胆囊壁增厚（比值比：2.33；95%置信区间，1.34-4.04；P=0.003）、手术时间超过 60 分钟（平均差异：-16.03；95%置信区间，-21.25 至-10.81；P<0.00001）和下午 1 点以后开始手术（比值比：4.20；95%置信区间，1.97-11.96；P=0.007）。性别（比值比：1.07；95%置信区间，0.73-1.57，P=0.73）和上腹部手术史（比值比：2.32；95%置信区间，0.92-5.82，P=0.07）与门诊腹腔镜胆囊切除术失败无关。
本荟萃分析确定了门诊腹腔镜胆囊切除术失败的预测因素。了解这些因素可以帮助外科医生在选择适合门诊腹腔镜胆囊切除术的患者时做出决策。
