Factors influencing successful discharge after outpatient laparoscopic cholecystectomy

Advanced laparoscopic and laser technologies have revolutionized the treatment of gallbladder disease. A new treatment, laparoscopic cholecystectomy, allows direct visualization of the abdominal cavity by means of a laparoscope and the removal of the gallbladder with only four small 0.5-inch incisions. For the majority of laparoscopic cholecystectomy patients, this service is provided in an ambulatory surgery or free-standing outpatient surgery center. Ambulatory surgery patients must meet established criteria before being discharged, but not all patients are successful in meeting discharge criteria. Many must be admitted overnight for further observation and treatment. Problems delaying discharge at one facility related to pain control, inability to ambulate, or uncontrolled nausea. This inability of patients to be discharged impacted on unit staffing, hospital productivity and cost, and patient satisfaction. This article discusses the factors that influenced the discharge outcome of patients undergoing elective laparoscopic cholecystectomy surgery at an ambulatory surgery center in an urban community hospital. Contributing factors included time of surgical procedure, comorbidity, premedication for pain (preemptive analgesia), and incisional local anesthesia. This information is important to providers caring for this patient population. Careful screening processes and development of treatment protocols related to the contributing factors will enhance the ability to safely discharge laparoscopic cholecystectomy patients.