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Risk factors for patient selection in ambulatory laparoscopic cholecystectomy: A Single-centre experience
Qiang Wu1, Ning Fu1, Weiwei Chen1
1Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China.
Insights
Ambulatory laparoscopic cholecystectomy is feasible, but patient selection is key. Pre-operative American Society of Anaesthesiologist (ASA) grading and leucocyte count are crucial risk factors for successful same-day discharge after gallbladder surgery.
Area of Science:
- Gastroenterology and Hepatobiliary Surgery
- Surgical Outcomes Research
- Patient Safety and Risk Management
Background:
- Ambulatory laparoscopic cholecystectomy (LC) offers benefits like reduced costs and increased hospital capacity.
- Patient selection criteria for ambulatory LC remain undefined, necessitating risk factor evaluation.
- Identifying predictors for successful ambulatory discharge is essential for optimizing patient care.
Purpose of the Study:
- To identify pre-operative risk factors associated with successful ambulatory discharge after laparoscopic cholecystectomy (LC).
- To analyze the relationship between patient variables and discharge readiness.
- To provide evidence-based criteria for selecting patients suitable for same-day discharge post-LC.
Main Methods:
- Retrospective analysis of 641 consecutive LC patients undergoing evaluation with the Post-Anaesthetic Discharge Scoring System.
- Statistical analysis to identify pre-operative variables predicting discharge fitness.
- Literature review to synthesize existing knowledge on ambulatory LC patient selection.
Main Results:
- American Society of Anaesthesiologist (ASA) grading and leucocyte count significantly predicted discharge fitness.
- Prolonged operation time (>55 min) was associated with inability to discharge, influenced by vital signs, activity, and pain/PONV.
- Male sex, BMI, leucocytes, and CRP predicted prolonged operative time.
Conclusions:
- Pre-operative ASA grade III and elevated leucocytes are significant risk factors for ambulatory discharge post-LC.
- Intraoperative factors, including prolonged surgery, also impact discharge readiness.
- Male sex, BMI, and CRP predict complicated surgery, requiring careful preoperative consideration for ambulatory LC.
Backgrounds:
Ambulatory laparoscopic cholecystectomy (LC) reduces healthcare cost and increases hospital bed capacity. Currently, there is no consensus on patient selection for ambulatory LC. Evaluation of risk factors for ambulatory discharge is essential.
Materials And Methods:
Consecutive patients who underwent LC in our centre throughout 2019 were collected. We evaluated the discharge fitness using the Post-Anaesthetic Discharge Scoring System at 8 h after the operation. The relations between pre-operative variables and dischargeable possibilities were analysed for screening risk factors. Furthermore, we performed a literature review to summarise all published information.
Results:
Six hundred and forty-one cases were included in this study. American Society of Anaesthesiologist (ASA) grading (odds ratio OR = 0.415, P = 0.001) and leucocytes (OR = 0.80, P < 0.001) significantly predicted the fitness of discharge. ASA contributed to lower activity (P = 0.002) and intake/output (P = 0.006) scores. Leucocytes influence the vital sign (P < 0.001) and pain or post-operative nausea and vomiting (PONV) (P < 0.001) scores. The prolonged operation could predict the inabilities of discharge with a cut-off value of 55 min by dropping vital signs (P = 0.011), activity (P < 0.001) and pain or PONV (P = 0.012) scores. Male sex (OR: 1.702, P = 0.010), body mass index (BMI) (OR: 1.087, P = 0.008), leucocytes (OR: 1.075, P = 0.017) and C-reactive protein (CRP) (OR: 1.018, P = 0.003) were predictors for prolonged operation (>55 min).
Conclusions:
We suggest that pre-operative ASA grading III and leucocytes are risk factors for the fitness of ambulatory discharge after LC and intraoperative time. Male, BMI and CRP predict complicated surgery, and they should be considered preoperatively.
