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Patient selection for ambulatory laparoscopic cholecystectomy: A systematic review
Weiwei Chen1, Qiang Wu1, Ning Fu1
1Department of Hepatobiliary and Vascular Surgery, The First Affiliated Hospital of Chengdu Medical College, Xindu, Chengdu, China.
Insights
Patient selection for ambulatory laparoscopic cholecystectomy (LC) lacks consensus. This review highlights variable criteria and suggests expanding surgical parameters for improved safety and same-day discharge rates.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Health Services Research
Background:
- Ambulatory laparoscopic cholecystectomy (LC) is increasingly utilized for gallbladder removal.
- Current patient selection criteria for same-day discharge LC lack standardization across institutions.
- This variability impacts the consistent application and safety of outpatient LC procedures.
Purpose of the Study:
- To systematically review existing literature on patient selection criteria for ambulatory LC.
- To summarize medical and surgical inclusion/exclusion criteria used in previous studies.
- To determine successful same-day discharge and readmission rates for ambulatory LC.
Main Methods:
- A comprehensive systematic literature search was conducted across major databases (PubMed, Web of Science, Embase, Google Scholar) up to March 2020.
- Data extraction focused on reported medical and surgical selection criteria, same-day discharge rates, and readmission rates.
- Fifty-nine studies encompassing 13,219 patients were included in the analysis.
Main Results:
- The median same-day discharge rate was 90%, with a median readmission rate of 2.22%.
- Commonly cited medical criteria included American Society of Anesthesiologists (ASA) class I-II, age <70, and BMI <35.
- Frequent surgical exclusion criteria were common bile duct stones/cholangitis/jaundice, prior abdominal surgery, and pancreatitis history.
Conclusions:
- Significant variability exists in patient selection for ambulatory LC.
- Medical selection criteria may be broadened with robust pre-anesthetic evaluation.
- Enhanced surgical selection, incorporating laboratory and imaging data, is recommended to ensure patient safety.
Background:
Currently, there is no consensus on patient selection for ambulatory laparoscopic cholecystectomy (LC). This study is a systematic review of previously published patient selection for ambulatory LC.
Methods:
A comprehensive search was done in PubMed, Web of Science, Embase and Google Scholar Database up to March 2020 to summarise previously reported medical or surgical selection criteria used for inclusion and exclusion of patients, as well as successful same-day discharge rates and readmission rate after discharge.
Results:
Fifty-nine studies with a total of 13,219 patients were included in this systematic review. In total, the median same-day discharge rate was 90% (range: 63%-99.4%), and median readmission rate was 2.22% (range: 0%-16.9%). The most considered medical criteria were American Society of Anesthesiologists classification I and II, age <70, and body mass index <35. Surgical criteria varied greatly. The top three accessible exclusion variables were (1) common bile duct stones, cholangitis, or jaundice (27 publications, 45.8%); (2) history of abdominal surgery (12 publications, 20.3%) and (3) history of pancreatitis (9 publications, 15.3%).
Conclusion:
The results of the current study showed the variable patient selection in different centres, the medical aspect criteria may be expanded under adequate pre-anaesthetic assessment and preparation and the surgical aspect criteria should include more laboratory or imaging parameters to ensure the surgical safety.
