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Readmissions after laparoscopic cholecystectomy in a UK District General Hospital
Olugbenga Awolaran1,2, Tabitha Gana3, Nehemiah Samuel3
1Department of General Surgery, Doncaster Royal Infirmary, Doncaster and Bassetlaw NHS Foundation Trust, Armthorpe Road, Doncaster, DN25LT, UK. gbenga_htouch@yahoo.com.
Insights
Readmission after laparoscopic cholecystectomy occurs in 6.7% of patients, often due to non-specific abdominal pain. Improving post-operative pain management and primary care support can reduce readmissions for this common gallstone surgery.
Area of Science:
- Surgical outcomes and patient safety in general surgery.
Background:
- Laparoscopic cholecystectomy is the standard treatment for symptomatic gallstones.
- Day case surgery is preferred, but readmission is a growing concern.
Purpose of the Study:
- To investigate the readmission rate following laparoscopic cholecystectomy.
- To identify causes of readmission and explore cost-effective management strategies.
Main Methods:
- A retrospective cohort study analyzed patients undergoing laparoscopic cholecystectomy over six months.
- Readmission within 30 days of surgery was assessed for elective and emergency cases.
Main Results:
- The readmission rate was 6.7% (22 out of 328 patients).
- The primary cause was non-specific abdominal pain (45.5%), followed by wound infection (22.7%).
- Readmission was lower with longer initial hospital stays, and 64% returned within 7 days.
Conclusions:
- Non-specific abdominal pain is a more frequent cause of readmission than severe complications.
- Multimodal pain management and enhanced primary care support are recommended to reduce readmissions and improve patient experience.
Introduction:
Laparoscopic cholecystectomy is the gold standard for the treatment of symptomatic gallstones and its practice as day case where possible is considered the standard over the last decade. However, readmission after surgery is recognised as a new problem.
Aim:
The aim of this cohort observational study was to investigate the readmission rate in a district general hospital and identify the causes of readmission in order to explore ways by which this can be reduced or managed more cost effectively.
Method:
Records of patients who had laparoscopic cholecystectomy over 6 months were retrospectively searched. Patients returning to hospital due to symptoms within 30 days of elective and emergency laparoscopic cholecystectomy were included.
Results:
Three hundred and twenty-eight laparoscopic cholecystectomies were performed within the 6-month period. Twenty-two patients returned within 30 days of surgery making a readmission rate of 6.7%. Reasons for inpatient admission were abdominal pain without any underlying cause 10 (45.5%), wound infection 5 (22.7%), leg swelling 2 (9%), retained stone 1 (4.5%), bile leak 1 (4.5%), pneumonia 1 (4.5%), iatrogenic bowel injury 1 (4.5%) and back pain 1 (4.5%). Readmission rate decreased with longer duration of stay in hospital during primary admission, and 64% of patients returned to the hospital within 7 days of procedure. 50% of patients who returned with abdominal pain without any identifiable cause had a longstanding history of conditions involving chronic pain.
Conclusion:
While the feared intra-abdominal complications of cholecystectomy often come to mind when assessing patients presenting with abdominal pain after surgery, non-specific abdominal pain is consistently shown to be several times more likely. A combination of patient factors and pain control techniques account for this pain. Effective multimodal pain management approach and community primary health care support in the early post-operative period could reduce readmission, save cost and improve patient experience.
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