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Predictive factors of long hospital stay after laparoscopic cholecystectomy
Yee-Yan Tsang1, Chi-Ming Poon, Kin-Wan Lee
1Department of Surgery, North District Hospital, New Territories, Hong Kong SAR.
Insights
Ambulatory laparoscopic cholecystectomy (LC) is feasible. Key factors for same-day discharge include patient selection, pain management, and early diet tolerance, reducing hospital stay after this common surgery.
Area of Science:
- Surgical Innovation
- Minimally Invasive Surgery
- Healthcare Management
Background:
- Laparoscopic cholecystectomy (LC) is the most common minimally invasive surgery in Hong Kong.
- Ambulatory LC is not widely practiced in Hong Kong, leading to longer hospital stays.
Purpose of the Study:
- Identify causes of prolonged hospital stay after elective LC.
- Develop a guideline for implementing ambulatory LC.
Main Methods:
- Retrospective analysis of 278 patients undergoing elective LC.
- Divided patients into short stay (SS) and long stay (LS) groups.
- Identified predictive factors for long hospital stay using univariate and multivariate analyses.
Main Results:
- 44.2% of patients were discharged within 24 hours; 55.8% had prolonged stays.
- Independent predictors for long hospital stay included age >60, delayed diet tolerance (>8 hours), and use of >2 oral analgesics.
- Older age, diet intolerance, and increased pain medication significantly increased the risk of extended hospitalization.
Conclusions:
- Ambulatory LC is feasible and safe with careful patient selection.
- Optimizing postoperative pain control and early diet resumption are crucial for successful ambulatory LC.
- Effective management of nausea and vomiting supports same-day discharge after LC.
Objective:
Laparoscopic cholecystectomy (LC) is the most common minimally invasive surgery in Hong Kong. However, ambulatory LC is not a common practice in Hong Kong. This study aims to identify the causes of long hospital stay after elective LC and to delineate a guideline for ambulatory LC.
Methods:
A retrospective analysis of 278 patients who underwent successful elective LC in a single unit between 1 January 2002 and 31 December 2003 was performed. They were divided into two groups: LS group had a long hospital stay (>24 hours after operation) and SS group had a short hospital stay. A total of 18 variables, including five patient variables, nine operative variables and four postoperative variables, were identified for univariate analysis. Significant pre- and postoperative factors were included in the multivariate analysis to identify independent predictive factors for long hospital stay.
Results:
Of the 278 patients, 118 (44.2%) could be discharged within 24 hours, while 149 (55.8%) had long hospital stay. Nine significant factors were identified in the univariate analysis; three independent factors were found to predict long hospital stay in the multivariate analysis. Patients with age more than 60 years had double risk of long hospital stay. Patients who could not tolerate diet within 8 hours or took more than two tablets of oral analgesia (dologesics) had a four- and threefold increase in risk of long hospital stay, respectively.
Conclusion:
With careful patient selection, optimal postoperative pain control and early resumption of diet with better management of postoperative nausea and vomiting, ambulatory LC was feasible and safe.
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