Fischer L, Watrinet K, Kolb G, Segendorf C, Huber B, Huck B
Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Str. 50, 76532, Baden-Baden, Deutschland.
Medizinische Fakultät, Universität Heidelberg, Heidelberg, Deutschland.
Chirurgie (Heidelb). 2022 Nov;93(11):1089-1094. doi: 10.1007/s00104-022-01713-9. Epub 2022 Sep 9.
The importance of postoperative control of laboratory parameters after elective laparoscopic cholecystectomy (lap-CHE) is controversial. The aim of this prospective study was to find out whether patients can be safely discharged following an inconspicuous perioperative course after lap-CHE without control of the laboratory parameters.
All patients with a lap-CHE from September 2020 to March 2022 were screened and included in the study after providing informed consent. The course was followed in a structured way with a scoring system (value 3-15 points) and questionnaire. A score of ≤ 9 reflected an inconspicuous perioperative course. Approval was obtained from the ethics committee of Heidelberg University (S-026/2020).
A total of 275 patients who underwent gall bladder surgery were documented of which 220 (80%) patients underwent an elective lap-CHE and 56 (25%) of the patients were included in the study. Of the patients 51 with a score of ≤ 9 were discharged without providing a blood sample. The average age of the patients was 50.8 years, the average duration of hospital stay was 2.6 days and 40 out of 51 (78.4%) patients could be postoperatively questioned. None of the patients suffered from relevant complications after being discharged. Out of 40 patients 27 (67.5) visited a general practitioner again postoperatively and 4 were readmitted as inpatients due to other operations and an endoscopic intervention. All patients were satisfied with the course of surgery.
Patients with an inconspicuous course after elective lap-CHE (score ≤ 9 points) can be discharged without a postoperative control of laboratory parameters.
择期腹腔镜胆囊切除术（lap-CHE）后实验室指标的术后监测的重要性存在争议。这项前瞻性研究的目的是确定在lap-CHE术后围手术期过程无异常且未监测实验室指标的情况下，患者是否能够安全出院。
对2020年9月至2022年3月期间接受lap-CHE的所有患者进行筛查，在获得知情同意后纳入研究。采用评分系统（分值3 - 15分）和问卷对病程进行结构化跟踪。评分≤9分反映围手术期过程无异常。获得了海德堡大学伦理委员会的批准（S-026/2020）。
共记录了275例接受胆囊手术的患者，其中220例（80%）接受了择期lap-CHE，56例（25%）患者纳入研究。51例评分≤9分的患者未提供血样即出院。患者的平均年龄为50.8岁，平均住院时间为2.6天，51例患者中有40例（78.4%）术后接受了询问。所有患者出院后均未出现相关并发症。40例患者中有27例（67.5%）术后再次就诊于全科医生，4例因其他手术和内镜干预再次住院。所有患者对手术过程均满意。
择期lap-CHE术后过程无异常（评分≤9分）的患者可以在不进行术后实验室指标监测的情况下出院。
