Structured outpatient cholecystectomy protocol leads to improving results and expanding indications

Outpatient laparoscopic cholecystectomy has become increasingly common, yet criteria for patient selection remain conservative. We aimed to assess the long-term outcomes of implementing a structured outpatient cholecystectomy protocol in a secondary hospital and explore its applicability in traditionally high-risk populations.

1024 consecutive elective cholecystectomy patients were retrospectively analyzed for initial indication for outpatient procedure, unplanned admission rate and complications since 2018, when our outpatient cholecystectomy protocol was established. Patient factors and operative parameters were assessed.

In 822 patients, the cholecystectomy was initially planned as an outpatient procedure, which was achieved in 673 (81.9%). Both the indication and success rates improved over time (P < .001). Unplanned admissions occurred mainly due to surgical complexity, social factors and timing of the procedure. Age > 70 years of age, BMI > 30, ASA III and complicated cholelithiasis were (except for prior acute cholecystitis) not found to increase the unplanned admission rate, and the indication for outpatient cholecystectomy in these groups rose over time without significant complications. 90-day readmission and complication rates (mostly Clavien-Dindo grade I-II and no mortality) remained low (1.3% and 3.6%, respectively; P < .001).

A structured protocol enables safe and effective expansion of outpatient cholecystectomy to higher-risk groups, optimizing resource utilization without compromising patient outcomes.