Department of Surgery, John Peter Smith Hospital, Fort Worth, Texas; Department of Surgery, Baylor University Medical Center, Dallas, Texas; Department of Surgical Research, Baylor Scott & White Research Institute, Dallas, Texas.
Department of Surgery, John Peter Smith Hospital, Fort Worth, Texas; Department of Surgery, Baylor University Medical Center, Dallas, Texas.
J Surg Res. 2023 Nov;291:396-402. doi: 10.1016/j.jss.2023.06.029. Epub 2023 Jul 5.
The utility of routine in-person clinic appointments after laparoscopic cholecystectomy (LC) is uncertain, especially after the increase of telehealth visits during the COVID-19 pandemic. The purpose of this study was to evaluate the utility of routine in-person follow-up for patients undergoing LC prior to changes implemented during the pandemic and to determine whether a return to routine in-person follow-up is warranted.
We retrospectively reviewed follow-up encounters for all patients undergoing LC from April 2018 to February 2020. All patients were routinely scheduled for in-person postoperative clinic follow-up 2-4 wk after discharge. Follow-up was considered nonroutine if new studies or medications were ordered, the patient was referred to the emergency department or readmitted, or malignancy was identified on pathology review.
Of 661 patients undergoing LC, 449 (68%) attended their scheduled in-person postoperative appointment and 212 (32%) did not. The postoperative appointment was nonroutine for 39 patients (9% of clinic attenders). Readmission occurred in 42 patients, with no differences between clinic attenders and nonattenders (P = 0.12). Furthermore, attending a postoperative clinic visit did not affect odds of readmission (odds ratio: 0.705, 95% confidence interval: 0.368, 1.351; P = 0.29). Readmission occurred on median day 9 after discharge in both groups.
The incidence of nonroutine follow-up after LC is low, and attendance at follow-up clinic was not associated with reduced readmissions. A return to routinely scheduling in-person follow-up 2-4 wk after discharge may not be warranted. Telehealth visits within 1 wk of discharge after LC should be considered.
腹腔镜胆囊切除术 (LC) 后常规门诊随访的实用性尚不确定，尤其是在 COVID-19 大流行期间增加远程医疗就诊之后。本研究旨在评估在大流行期间实施变革之前接受 LC 治疗的患者进行常规门诊随访的实用性，并确定是否有必要恢复常规门诊随访。
我们回顾性分析了 2018 年 4 月至 2020 年 2 月期间所有接受 LC 治疗的患者的随访记录。所有患者均在出院后 2-4 周常规安排门诊术后随访。如果新的研究或药物被开处方、患者被转至急诊部门或再次入院，或者病理检查发现恶性肿瘤，则认为随访是非常规的。
在 661 例接受 LC 的患者中，449 例（68%）按计划接受了门诊术后预约，212 例（32%）未接受。门诊就诊者中有 39 例（9%）的术后预约为非常规。42 例患者再次入院，门诊就诊者和非就诊者之间无差异（P=0.12）。此外，就诊门诊并不会影响再次入院的几率（比值比：0.705，95%置信区间：0.368，1.351；P=0.29）。两组患者均在出院后第 9 天中位数日再次入院。
LC 后非常规随访的发生率较低，且就诊门诊与降低再入院率无关。可能没有必要恢复在出院后 2-4 周常规安排门诊随访。应考虑在 LC 出院后 1 周内进行远程医疗就诊。
