Analysis of delayed discharge after day-surgery laparoscopic cholecystectomy

Cao, Junning; Liu, Bo; Li, Xiangjun; Leng, Jian-jun; Meng, Xiangjun; Pan, Yingwei; Dou, Songmeng; Lu, Shichun

doi:10.1016/j.ijsu.2017.02.055

Cited by 11 publications

(10 citation statements)

References 21 publications

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“…As the previously reported incidence of complications ranges from 4.8% to 15.7%, conversion to open surgery ranges from 0% to 3.0% and readmission ranges from 0% to 6.1%, 11–15,22,24 the differences between elderly patients and non‐elderly patients in this study in the incidence of complications (7.8% versus 7.9%), conversion to open surgery (0.7% versus 0.5%) and readmission within 30 days after discharge (0.5% versus 0.4%) were not statistically significant, which suggested no higher risk of these outcomes in elderly patients undergoing ALC. Additionally, Clavien‐Dindo I and II complications accounted for 92.2% of postoperative complications in elderly patients (Fig.…”

Section: Discussionsupporting

confidence: 54%

“…Our study showed that all 1143 elderly patients undergoing ALC were cured, and the incidence of postoperative discharge within 24 h was 75.5%. The reasons for delayed discharge included psychosocial reasons, complications, drainage and conversion to open surgery, all of which have been reported in other studies 13–15,22,23 . There were fewer elderly patients than non‐elderly patients with postoperative discharge within postoperative 24 hours (75.5% versus 81.7%), which mainly resulted from the higher incidence of delayed discharge due to drainage (7.8% versus 3.2%) in elderly patients than in non‐elderly patients.…”

Section: Discussionmentioning

confidence: 59%

“…Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of benign gallbladder diseases. Since ambulatory laparoscopic cholecystectomy (ALC) was first reported in 1990, 10 it has been successfully performed in increasingly more countries with adequate feasibility and a reduction in cost 11–16 . Although LC in the elderly is feasible and safe, 17,18 the safety of ALC in the elderly remains controversial.…”

Section: Introductionmentioning

confidence: 99%

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Safety of ambulatory laparoscopic cholecystectomy in the elderly

Cao

Liu

Shi

et al. 2021

ANZ Journal of Surgery

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Background This study aims to retrospectively analyse the safety of ambulatory laparoscopic cholecystectomy (ALC) and identify risk factors for delayed discharge after ALC in the elderly. Methods Consecutive patients who were scheduled to undergo ALC were assigned to the elderly group (age ≥ 65 years) or the non‐elderly group. The primary outcome was postoperative discharge within 24 h (D24). Secondary outcomes were perioperative mortality, reasons for delayed discharge (psychosocial reasons (DP), complications (DC), drainage (DD) and conversion to open surgery (DCO)), intraoperative data and readmission within 30 days after discharge (readmission). Differences were statistically significant when P < 0.05. Results There were 7657 patients assigned to the elderly group (n = 1143) or the non‐elderly group (n = 6514). The differences between elderly patients and non‐elderly patients in the operation time (51.0 (37.0–70.0) versus 50.0 (35.0–65.0) min), blood loss (10.0 (5.0–10.0) versus 5.0 (5.0–10.0) mL), D24 (75.5% versus 81.7%) and DD (7.8% versus 3.2%) were statistically significant (P < 0.05, respectively). The differences between elderly patients and non‐elderly patients in DP (8.2% versus 6.7%), DC (7.8% versus 7.9%), DCO (0.7% versus 0.5%) and readmission (0.5% versus 0.4%) were not statistically significant (P > 0.05, respectively). Independent risk factors for delayed discharge after ALC in the elderly were male sex, octogenarian status, prolonged operation time, arrhythmia, type 2 diabetes mellitus, a previous operation in the upper abdomen, acute inflammation of gallbladder and a gallbladder wall thicker than 3 mm (P < 0.05, respectively). Conclusion ALC in the elderly is feasible and safe.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

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Safety of ambulatory laparoscopic cholecystectomy in the elderly

Cao

Liu

Shi

et al. 2021

ANZ Journal of Surgery

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“…Classical discharge criteria are still valid to secure safe and effective discharge following surgery/anesthesia. Commonly described limiting factors for failed early discharge are; not showing robust stable vital signs, not being able to control of pain and PONV with oral medications not able to ambulation unaided and, not being adequately cognitive restored to manage self-care, patient and caregivers uncertainty to leave hospital [20 ▪▪ ,64,65]. Not being able to urinate and/or urinary retention is also a frequent failure course [66,67 ▪ ,68 ▪ ].…”

Section: Logisticsmentioning

confidence: 99%

Ambulatory anesthesia and discharge: an update around guidelines and trends

Rohi

Olofsson

Jakobsson

2022

Current Opinion in Anaesthesiology

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Purpose of reviewProvide an oversight of recent changes in same-day discharge (SDD) of patient following surgery/anesthesia.Recent findingsEnhanced recovery after surgery pathways in combination with less invasive surgical techniques have dramatically changed perioperative care. Preparing and optimizing patients preoperatively, minimizing surgical trauma, using fast-acting anesthetics as well as multimodal opioid-sparing analgesia regime and liberal prophylaxis against postoperative nausea and vomiting are basic cornerstones. The scope being to maintain physiology and minimize the impact on homeostasis and subsequently hasten and improve recovery.SummaryThe increasing adoption of enhanced protocols, including the entire perioperative care bundle, in combination with increased use of minimally invasive surgical techniques have shortened hospital stay. More intermediate procedures are today transferred to ambulatory pathways; SDD or overnight stay only. The traditional scores for assessing discharge eligibility are however still valid. Stable vital signs, awake and oriented, able to ambulate with acceptable pain, and postoperative nausea and vomiting are always needed. Drinking and voiding must be acknowledged but mandatory. Escort and someone at home the first night following surgery are strongly recommended. Explicit information around postoperative care and how to contact healthcare in case of need, as well as a follow-up call day after surgery, are likewise of importance. Mobile apps and remote monitoring are techniques increasingly used to improve postoperative follow-up.

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“…Approximately one-half of the patients (44%) living at home before surgery were discharged to rehabilitation facilities after surgery (19). Other areas of research, such as day-surgery laparoscopic cholecystectomy, have reported some factors responsible for delayed discharge, including psychosocial factors (20). On the one hand, patients usually believe that they should get more professional care than unsupervised rehabilitation at home.…”

Section: Psychological Factorsmentioning

confidence: 99%

Why does patients’ discharge delay after vertebral augmentation? A factor analysis of 1,442 patients

et al. 2022

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ObjectiveVertebral augmentation techniques are widely used to treat osteoporotic vertebral compression fractures (OVCFs). Superior analgesic effects and shortened bed rest time means patients recover quickly, but prolonged unscheduled hospitalization can increase medical expenses and the risk of bed rest complications. The aim of this study was to investigate the reasons for prolonged hospitalization after vertebral augmentation surgery and to determine the relative risk factors.MethodsA single-center retrospective study was conducted to enroll patients with OVCFs and accepted vertebral augmentation surgery from January 2017 to December 2017. Clinical information was collected from the Hospital Information System (HIS). The criterion of delayed discharge was postoperative hospitalization more than 3 days. Telephone interviews and medical history evaluations were conducted to confirm the exact reason for retention. The risk factors were analyzed by multiple logistic regression.ResultsOverall, 1,442 patients were included, and 191 (13.2%) stayed in the hospital for more than 3 days postoperatively. The reasons for delayed discharge were psychological factors (37.2%), residual pain (32.5%), cardiopulmonary complications (15.7%), nonspecific symptoms (8.4%), incision abnormalities (2.6%), thrombosis (2.1%), and postanesthesia reactions (1.6%). The multiple logistic model was significant; age (OR 1.028; 95% CI 1.009–1.046), preoperative stay (OR 1.192; 95% CI 1.095–1.298), operation type (OR 1.494; 95% CI 1.019–2.189), and the number of surgical segments (OR 2.238; 95% CI 1.512–3.312) showed statistical significance. In contrast, gender (P > 0.1) and chronic comorbidities (P > 0.1) were not predictors in this model.ConclusionOverall, 13.2% of OVCF patients who underwent vertebral augmentation surgery were not discharged within 3 days postoperatively, and several predictors were found. Preoperative communication and comprehensive evaluations are calling for more attention; physicians should adopt an appropriate medical process to enhance rehabilitation in geriatric orthopedics.

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Analysis of delayed discharge after day-surgery laparoscopic cholecystectomy

Cited by 11 publications

References 21 publications

Safety of ambulatory laparoscopic cholecystectomy in the elderly

Safety of ambulatory laparoscopic cholecystectomy in the elderly

Ambulatory anesthesia and discharge: an update around guidelines and trends

Why does patients’ discharge delay after vertebral augmentation? A factor analysis of 1,442 patients

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