Surgical Endoscopy

, Volume 22, Issue 9, pp 1928–1934

A meta-analysis of ambulatory versus inpatient laparoscopic cholecystectomy

Review

Abstract

Background

Laparoscopic cholecystectomy is increasingly used on an ambulatory basis. This study aimed to examine its effectiveness for carefully selected patients.

Methods

A systematic review of Cochrane, Embase, and Medline using the keywords “ambulatory,” “laparoscopic,” and “cholecystectomy” was performed. Postoperative complications leading to admissions and readmissions were compared between day care and inpatient laparoscopic cholecystectomy groups. Postoperative quality of life, patient satisfaction, and cost effectiveness also were analyzed.

Results

The search process identified seven clinical trials suitable for meta-analysis. These trials, consisting of 598 patients, compared day care and inpatient procedures. The unplanned admission rate in the ambulatory group was comparable with the prolonged hospitalization of inpatients (odds ratio [OR], 1.979; 95% confidence interval [CI], 0.846–4.628). There was no significant difference between the readmission rates of the two groups (OR, 0.964; 95% CI, 0.318–2.922). The quality-of-life indicators were similar for the ambulatory and overnight-stay patients (p = 0.195). The cost effectiveness was better for the day care procedures because of the shorter mean hospital stay.

Conclusion

Ambulatory laparoscopic cholecystectomy can be performed safely for selected patients, with reduced cost and a high level of patient satisfaction.

Keywords

Ambulatory Cholecystectomy Laparoscopic 

References

  1. 1.
    Perissat J, Collet DR, Belliard R (1989) Gallstones: iaparoscopic treatment, intracorporeal lithotripsy followed by cholecystostomy or cholecystectomy: a personal technique. Endoscopy 21(Suppl 1):373–374PubMedGoogle Scholar
  2. 2.
    Reddick EJ, Olsen DO (1990) Outpatient laparoscopic laser cholecystectomy. Am J Surg 160:485–487PubMedCrossRefGoogle Scholar
  3. 3.
    Chauhan A, Mehrotra M, Bhatia PK, Baj B, Gupta AK (2006) Day care laparoscopic cholecystectomy: a feasibility study in a public health service hospital in a developing country. World J Surg 30:1690–1695PubMedCrossRefGoogle Scholar
  4. 4.
    Wenner DE, Whitwam P, Turner D, Chadha A, Degani J (2006) Laparoscopic cholecystectomy and management of biliary tract stones in a freestanding ambulatory surgery centre. JSLS 10:47–51PubMedGoogle Scholar
  5. 5.
    Skattum J, Edwin B, Trondsen W, Mjaland O, Raede J, Buanes T (2004) Outpatient laparoscopic surgery: feasibility and consequences for education and health care costs. Surg Endosc 18:796–801PubMedCrossRefGoogle Scholar
  6. 6.
    Keulemans Y, Eshuis J, de Haes H, de Wit LT, Gouma DJ (1998) Laparoscopic cholecystectomy: day-care versus clinical observation. Ann Surg 228:734–740PubMedCrossRefGoogle Scholar
  7. 7.
    Hollington P, Toogood GJ, Padbury RT (1999) A prospective randomized trial of day-stay only versus overnight-stay laparoscopic cholecystectomy. Aust N Z J Surg 69:841–843PubMedCrossRefGoogle Scholar
  8. 8.
    Dirksen CD, Schmitz RF, Hans KM, Nieman FHM, Hoogenboom LJ, Go PMNYH (2001) Laparoscopic cholecystectomy in an ambulatory treatment is just as effective as an overnight stay and from a social perspective is cheaper: a randomised study. Ned Tijdschr Geneesk 145:2434–2439Google Scholar
  9. 9.
    Young J, O’Connell B (2001) Recovery following laparoscopic cholecystectomy in either a 23-h or an 8-h facility. J Qual Clin Pract 21:2–7PubMedCrossRefGoogle Scholar
  10. 10.
    Curet MJ, Contreras M, Weber DM, Albrecht R (2002) Laparoscopic cholecystectomy: outpatient vs inpatient management. Surg Endosc 16:453–457PubMedCrossRefGoogle Scholar
  11. 11.
    Sharma A, Hayden JD, Reese RA, Sedman PC, Royston CMS, O’Boyle CJ (2004) Prospective comparison of ambulatory with inpatient laparoscopic cholecystectomy: outcome, patient preference, and satisfaction. J Ambulatory Surg 11:23–26CrossRefGoogle Scholar
  12. 12.
    Johansson M, Thune A, Nelvin L, Lundell L (2006) Randomized clinical trial of day-care versus overnight-stay laparoscopic cholecystectomy. Br J Surg 93:40–45PubMedCrossRefGoogle Scholar
  13. 13.
    Lau H, Brooks DC (2002) Transitions in laparoscopic cholecystectomy: the impact of ambulatory surgery. Surg Endosc 16:323–326PubMedCrossRefGoogle Scholar
  14. 14.
    Lam D, Miranda R, Hom SJ (1997) Laparoscopic cholecystectomy as an outpatient procedure. J Am Coll Surg 185:152–155PubMedGoogle Scholar
  15. 15.
    Voyles CR, Berch BR (1997) Selection criteria for laparoscopic cholecystectomy in an ambulatory care setting. Surg Endosc 11:1145–1146PubMedCrossRefGoogle Scholar
  16. 16.
    Robinson TN, Biffl WL, Moore EE, Heimbach JK, Calkins CM, Burch JM (2002) Predicting failure of outpatient laparoscopic cholecystectomy. Am J Surg 184:515–519CrossRefGoogle Scholar
  17. 17.
    Metcalfe MS, Mullin EJ, Maddern GJ (2006) Relaxation of the criteria for day surgery laparoscopic cholecystectomy. ANZ J Surg 76:142–144PubMedCrossRefGoogle Scholar
  18. 18.
    Voitk AJ (1997) Is outpatient cholecystectomy safe for the higher-risk elective patient? Surg Endosc 11:1147–1149PubMedCrossRefGoogle Scholar
  19. 19.
    Fiorillo MA, Davidson PG, Fiorillo M et al (1996) 149 Ambulatory laparoscopic cholecystectomies. Surg Endosc 10:52–56PubMedCrossRefGoogle Scholar
  20. 20.
    Mjaland O, Reader J, Aasboe V et al (1997) Outpatient laparoscopic cholecystectomy. Br J Surg 84:958–961PubMedCrossRefGoogle Scholar
  21. 21.
    Leeder PC, Mathews T, Krzeminska K, Dehn TCB (2004) Routine day-case laparoscopic cholecystectomy. Br J Surg 91:312–316PubMedCrossRefGoogle Scholar
  22. 22.
    Lillemoe KD, Lin JW, Talamini MA, Yeo CJ, Synder DS, Parker SD (1999) Laparoscopic cholecystectomy as a “true” outpatient procedure: initial experience in 130 consecutive patients. J Gastrointest Surg 3:44–49PubMedCrossRefGoogle Scholar
  23. 23.
    Lau H, Brooks DC (2002) Contemporary outcomes of ambulatory laparoscopic cholecystectomy in a major teaching hospital. World J Surg 26:1117–1121PubMedCrossRefGoogle Scholar
  24. 24.
    Yang H, Choi PT, McChesney J, Buckley N (2004) Induction with sevoflurane-remifentanil is comparable to propofol-fentanyl-rocuronium in PONV after laparoscopic surgery. Can J Anaesth 51:660–667PubMedGoogle Scholar
  25. 25.
    Coloma M, White PF, Markowitz SD, Whitten CW, Macaluso AR, Berrisford SB, Thornton KC (2002) Dexamethasone in combination with dolasetron for prophylaxis in the ambulatory setting: effect on outcome after laparoscopic cholecystectomy. Anaesthesiology 96:1346–1350CrossRefGoogle Scholar
  26. 26.
    Liberman MA, Howe S, Lane M (2000) Ondansetron versus placebo for prophylaxis of nausea and vomiting in patients undergoing ambulatory laparoscopic cholecystectomy. Am J Surg 179:60–62Google Scholar
  27. 27.
    Parlow JL, Meikle AT, van Vlymen J, Avery N (1999) Postdischarge nausea and vomiting after ambulatory laparoscopy is not reduced by promethazine prophylaxis. Can J Anaesth 46:719–724PubMedGoogle Scholar
  28. 28.
    Reader JC, Mjaland O, Aasbo V, Grogaard B, Buanes T (1998) Desflurane versus propofol maintenance for outpatient laparoscopic cholecystectomy. Acta Anaesthesiol Scand 42:106–110Google Scholar
  29. 29.
    McGrath B, Elgendy H, Chung F, Kamming D, Curti B, King S (2004) Thirty percent of patients have moderate to severe pain 24 h after ambulatory surgery: a survey of 5,703 patients. Can J Anaesth 51:886–891PubMedGoogle Scholar
  30. 30.
    Chung F, Tong D, Miceli PC, Reiz J, Harsanyi Z, Darke AC, Payne LW (2004) Controlled-release codeine is equivalent to acetaminophen plus codeine for postcholecystectomy analgesia. Can J Anaesth 51:216–221PubMedGoogle Scholar
  31. 31.
    Michaloliakou C, Chung F, Sharma S (1996) Preoperative multimodal analgesia facilitates recovery after ambulatory laparoscopic cholecystectomy. Anesth Analg 82:44–51PubMedCrossRefGoogle Scholar
  32. 32.
    Wilson YG, Rhodes M, Ahmed R, Daugherty M, Cawthorn SJ, Armstrong CP (1994) Intramuscular diclofenac sodium for postoperative analgesia after laparoscopic cholecystectomy: a randomised, controlled trial. Surg Laparosc Endosc 4:340–344PubMedGoogle Scholar
  33. 33.
    Tsimoyiannis EC, Glantzounis G, Lekkas ET, Siakas P, Jabarin M, Tzourou H (1998) Intraperitoneal normal saline and bupivacaine infusion for reduction of postoperative pain after laparoscopic cholecystectomy. Surg Laparosc Endosc 8:416–420PubMedCrossRefGoogle Scholar
  34. 34.
    O’Hanlon DM, Colbert S, Ragheb J, McEntee GP, Chambers F, Moriarty DC (2004) Intraperitoneal pethidine versus intramuscular pethidine for the relief of pain after laparoscopic cholecystectomy: randomized trial. Can J Anaesth 51:216–221CrossRefGoogle Scholar
  35. 35.
    Johnston SM, Kidney S, Sweeney KJ, Zaki A, Tanner WA, Keane FV (2003) Changing trends in the management of gallstone disease. Surg Endosc 17:781–786. Epub 2003 Feb 17PubMedCrossRefGoogle Scholar
  36. 36.
    Narain PK, DeMaria EJ (1997) Initial results of a prospective trial of outpatient laparoscopic cholecystectomy. Surg Endosc 11:1091–1094PubMedCrossRefGoogle Scholar
  37. 37.
    Zegarra RF II, Saba AK, Peschiera JL (1997) Outpatient laparoscopic cholecystectomy: safe and cost effective? Surg Laparosc Endosc 7:487–490PubMedCrossRefGoogle Scholar
  38. 38.
    Critchlow JT, Paugh LM (1999) Is 24-h observation necessary after elective laparoscopic cholecystectomy? South Med J 92:1089–1092PubMedCrossRefGoogle Scholar
  39. 39.
    Rosen MJ, Malm JA, Tarnoff M, Zuccala K, Ponsky JL (2001) Cost effectiveness of ambulatory laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 11:182–184PubMedCrossRefGoogle Scholar
  40. 40.
    Vuilleumier H, Halkic N (2004) Laparoscopic cholecystectomy as a day surgery procedure: implementation and audit of 136 consecutive cases in a university hospital. World J Surg 28:737–740. Epub 2004 AugPubMedCrossRefGoogle Scholar
  41. 41.
    Blatt A, Chen S (2003) Day-only laparoscopic cholecystectomy in a regional teaching hospital. ANZ J Surg 73:321–325PubMedCrossRefGoogle Scholar
  42. 42.
    Fassiadis N, Pepas L, Grandy-Smith S, Paix A, EI-Hasani S (2004) Outcome and patient acceptance of outpatient laparoscopic cholecystectomy. JSLS 8:251–343PubMedGoogle Scholar
  43. 43.
    Ammori BJ, Davides D, Vezakis A, Martin IG, Larvin M, Smith S, Gibson JS, McMahon MJ (2003) Day-case laparoscopic cholecystectomy: a prospective evaluation of a experience. J Hepatobiliary Pancreat Surg 10:303–308PubMedCrossRefGoogle Scholar
  44. 44.
    Siu WT, Leong HT, Law BK, Onsiong SM, Fung KH, Li AC, Tai YP, Li MK (2001) Outpatient laparoscopic cholecystectomy in Hong Kong: patient acceptance. Surg Laparosc Endosc Percutan Tech 11:92–96PubMedCrossRefGoogle Scholar
  45. 45.
    Richardson WS, Fuhrman GS, Burch E, Bolton JS, Bowen JC (2001) Outpatient laparoscopic cholecystectomy in Hong Kong: patient acceptance. Surg Endosc 15:193–195PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Midwestern Regional HospitalEnnisRepublic of Ireland

Personalised recommendations