Timing of unplanned admission following daycare laparoscopic cholecystectomy

- Laparoscopic cholecystectomy can be performed successfully in a daycare setting.
- A four hour postoperative observation time is sufficient following a laparoscopic cholecystectomy.
- Success of daycare surgery decreases in older patients, and in those with a complex medical history.
- The success of daycare surgery relies upon a multidisciplinary approach.

BackgroundOutpatient laparoscopic cholecystectomy is the treatment of choice for symptomatic biliary colic. There is controversy regarding the optimal candidate, and postoperative observation time for patients receiving daycare laparoscopic cholecystectomy.MethodsA retrospective, multi-centred, case-control chart review was performed from January 1, 2009 to December 31, 2011 on consecutive patients undergoing planned laparoscopic cholecystectomy. Patient demographics, surgical details, and postoperative details were analyzed.Results1256 daycare laparoscopic cholecystectomies were performed. One-hundred and twenty-one (9.6%) required unplanned admission the day of surgery. Forty (3.2%) were re-admitted within one month of surgery. The median time from surgical procedure to unplanned day of surgery admission was 218 min ± 143. The unplanned admission patients were older (54.6 vs 45.1, p < 0.005), and had ASA scores 3 or higher (24% vs 3%, p < 0.005). Comorbid conditions associated with unplanned admissions included hypertension, cardiac conditions, and chronic pain.ConclusionsThe majority of patients can be successfully managed with daycare laparoscopic cholecystectomy. A median time of 4 h is sufficient for postoperative observation. Risk factors for unplanned admission include age, ASA, hypertension, diabetes, and chronic pain.