Same day discharge protocol implementation trends in laparoscopic cholecystectomy in pediatric patients

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Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture
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Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture

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Joanna L Gould1, Ashwini S Poola1, Shawn D St Peter1

  • 1Department of Surgery, Children's Mercy Hospital, Kansas City, MO.

Journal of Pediatric Surgery
|September 27, 2016
PubMed

Insights

Implementing a standardized protocol significantly increased same-day discharge (SDD) rates after laparoscopic cholecystectomy (LC). This approach is safe and effective, with no increase in complications for patients discharged on the same day.

Area of Science:

  • Surgical outcomes
  • Patient safety
  • Healthcare protocols

Background:

  • Laparoscopic cholecystectomy (LC) is a common surgical procedure.
  • Same-day discharge (SDD) after LC has potential benefits but faces barriers.
  • Investigating and overcoming these barriers is crucial for optimizing patient care.

Purpose of the Study:

  • To identify barriers to same-day discharge (SDD) after laparoscopic cholecystectomy (LC).
  • To implement and evaluate a standardized clinical protocol to improve SDD success rates.
  • To assess the safety and efficacy of SDD after LC.

Main Methods:

  • Prospective observational study comparing two periods (January 2013-July 2014 and July 2014-2015).
  • Analysis of 191 laparoscopic cholecystectomies (LCs).
  • Comparison of SDD rates, postoperative complications, and readmissions between the two periods.

Main Results:

  • Same-day discharge (SDD) rates increased from 47% in the first period to 78% in the second period (P<0.001).
  • No significant differences in postoperative complications or readmissions were observed between SDD patients and those admitted overnight.
  • Identified no specific patient factors (age, BMI, gender) predicting admission; most admissions were for non-specific reasons like pain or emesis.

Conclusions:

  • Same-day discharge (SDD) following laparoscopic cholecystectomy (LC) is a safe and effective practice.
  • A standardized clinical protocol, with continuous refinement, can significantly enhance SDD success rates.
  • Optimizing protocols can lead to improved patient throughput and potentially reduced healthcare costs.
Abstract

Keywords:
Biliary dyskinesiaCholecystectomyProtocolSame day dischargeSymptomatic cholelithiasis

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