Prospective 5-year audit for day-case laparoscopic cholecystectomy

AIMS: Laparoscopic cholecystectomy can be performed as a day-case procedure but success depends on adequate recovery time, patient motivation and physical condition. To determine the proportion of patients suitable for a day-case procedure, 23-h stay and inpatient treatment, a prospective audit was introduced in 1994. METHODS: A 5-year (1994-1999) prospective annual audit was performed for all patients undergoing laparoscopic cholecystectomy (537 patients). In the first 3 years patients were either classified as day-case or inpatient stay; the establishment of a 23-h stay ward allowed a third option for these patients. RESULTS: Day-case laparoscopic cholecystectomy, including 23-h stay in the final 2 years of the audit, increased in each of the 5 years from 16 to 80 per cent. The audit loop was closed when the successful allocation rate for day-case patients was reaudited; this increased from 56 per cent in the first year to 88 per cent in the final year. CONCLUSIONS: This audit has identified the need for extended recovery for patients undergoing more major procedures on an ambulatory basis such as laparoscopic cholecystectomy. Further refinements in selection criteria and improved analgesia control are needed to reduce the unexpected extended stay for day-case and ambulatory patients.