Abstract
Background
Currently, most patients undergoing laparoscopic cholecystectomy (LC) in Switzerland are inpatients for 2–3 days. Due to a lack of available hospital beds, we asked whether day-case surgery would be an option for patients in central Switzerland. The questions of acceptability of outpatient LC and factors contributing to the acceptability thus arose.
Methods
Hundred patients suffering from symptomatic cholecystolithiasis, capable of communicating in German, and between 18 and 65 years old, were included. Patients received a pre-operative questionnaire on medical history and social situation when informed consent on surgery and participation in the study was obtained. Exclusion criteria were patients suffering from acute cholecystitis or any type of cancer; having a BMI >40 kg/m2; needing conversion to open cholecystectomy or an intraoperative drainage; and non-German speakers. Surgery was performed laparoscopically. Both surgeon and patient filled in a postoperative questionnaire. The surgeon’s questionnaire listed medical and technical information, and the patients’ questionnaire listed medical information, satisfaction with the treatment and willingness to be released on the same day. These data from both questionnaires were grouped into social and medical factors and analysed on their influence upon willingness to accept an ambulatory procedure. No outpatient follow-up apart from checking for readmission to our hospital within 1 month after discharge was performed.
Results
Of the 100 participants, one-third was male. More than two-thirds were Swiss citizens. Only one participant was ineligible for rapid release evaluation due to need of a drainage. Among the social factors contributing to the acceptability of ambulatory care, we found nationality to be relevant; Swiss citizens preferred an inpatient procedure, whereas non-Swiss citizens were significantly more willing to return home on the same day. Household size, sex and age did not correlate with a preference for inpatient care in our study population. Furthermore, medical input factors such as the surgeon’s level of experience, operation time or use of local anaesthesia at the end of surgery had also no significant influence on whether patients preferred inpatient care or not. Medical output factors not found to contribute to the patients’ decisions included co-morbidities or postoperative nausea and vomiting (PONV). Patients of experienced surgeons reported significantly less pain at the operation site. This was correlated with a somewhat increased willingness to accept ambulatory treatment.
Conclusion
Given the choice, about half of the LC patients in central Switzerland prefer to stay in hospital overnight. PONV, age, sex or social surroundings were not predictive of the preferred treatment modality. Only being a non-Swiss citizen and experiencing little pain at the operation site due to the surgeon’s skills seem to be factors that lead to a preference for ambulatory LC (ALC). Therefore, ALC in central Switzerland is most acceptable to non-Swiss citizens, operated upon by experienced surgeons.
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References
Arregui ME, Davis CJ, Arkush A et al (1991) In selected patients outpatient laparoscopic cholecystectomy is safe and significantly reduces hospitalization charges. Surg Laparosc Endosc 1:240–245
Mjaland O, Raeder J, Aasboe V et al (1997) Outpatient laparoscopic cholecystectomy. Br J Surg 84:958–961
Prasad A, Foley RJ (1996) Day case laparoscopic cholecystectomy: a safe and cost effective procedure. Eur J Surg 162:43–46
Brescia A, Gasparrini M, Nigri G et al (2013) Laparoscopic cholecystectomy in day surgery: feasibility and outcomes of the first 400 patients. Surgeon 11(Suppl 1):S14–S18
Planells Roig M, Garcia Espinosa R, Cervera Delgado M et al (2013) Ambulatory laparoscopic cholecystectomy. A cohort study of 1600 consecutive cases. Cir Esp 91:156–162
Vaughan J, Gurusamy KS, Davidson BR (2013) Day-surgery versus overnight stay surgery for laparoscopic cholecystectomy. Cochrane Database Syst Rev (7):CD006798. doi:10.1002/14651858.CD006798.pub4
Dirksen CD, Schmitz RF, Hans KM et al (2001) Ambulatory laparoscopic cholecystectomy is as effective as hospitalization and from a social perspective less expensive: a randomized study. Ned Tijdschr Geneeskd 145:2434–2439
Johansson M, Thune A, Nelvin L et al (2006) Randomized clinical trial of day-care versus overnight-stay laparoscopic cholecystectomy. Br J Surg 93:40–45
Keulemans Y, Eshuis J, de Haes H et al (1998) Laparoscopic cholecystectomy: day-care versus clinical observation. Ann Surg 228:734–740
Kumar S, Ali S, Ahmad S et al (2015) Randomised controlled trial of day-case laparoscopic cholecystectomy vs routine laparoscopic cholecystectomy. Indian J Surg 77:520–524
Siu WT, Leong HT, Law BK et al (2001) Outpatient laparoscopic cholecystectomy in Hong Kong: patient acceptance. Surg Laparosc Endosc Percutan Tech 11:92–96
Sato A, Terashita Y, Mori Y et al (2012) Ambulatory laparoscopic cholecystectomy: an audit of day case vs overnight surgery at a community hospital in Japan. World J Gastrointest Surg 4:296–300
Robinson TN, Biffl WL, Moore EE et al (2002) Predicting failure of outpatient laparoscopic cholecystectomy. Am J Surg 184:515–518 (discussion 518–519)
Psaila J, Agrawal S, Fountain U et al (2008) Day-surgery laparoscopic cholecystectomy: factors influencing same-day discharge. World J Surg 32:76–81. doi:10.1007/s00268-007-9225-x
Pujahari AK (2016) Day care vs overnight stay after laparoscopic cholecystectomy even with co-morbidity and a possible second surgery: a patient’s choice. J Clin Diagn Res 10:PC25–PC27
Abet E, Orion F, Denimal F et al (2017) Interest of using ropivacaine for outpatient laparoscopic cholecystectomy: prospective randomized trial. World J Surg 41:687–692. doi:10.1007/s00268-016-3797-2
Acknowledgements
We thank Lauren D. Matheson, Weilheim i.OB., Germany, for proofreading and inputs on the manuscript.
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Drs. Widjaja, Fischer, Brunner, Honigmann and Metzger have no conflicts of interest or financial ties to disclose.
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Widjaja, S.P., Fischer, H., Brunner, A.R. et al. Acceptance of Ambulatory Laparoscopic Cholecystectomy in Central Switzerland. World J Surg 41, 2731–2734 (2017). https://doi.org/10.1007/s00268-017-4098-0
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DOI: https://doi.org/10.1007/s00268-017-4098-0