Increasing success in outpatient laparoscopic cholecystectomy by an optimal clinical pathway

Greilsamer, Tristan; Orion, François; Denimal, F.; Kerviler, B. de; Jean, Marc-Henri; Dimet, Jérôme; Comy, Michel; Abet, E.

doi:10.1111/ans.14297

Cited by 6 publications

(5 citation statements)

References 13 publications

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“…Implementation of a dedicated care pathway for patients undergoing elective LC was examined in 10 non-randomized studies. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 14 , 31 , 32 Implementation of a care pathway was associated with a significantly shorter mean LOS (MD 24.9 h; 95% CI, 18.7–31.2; p < 0.001; Fig. 3 a) and an improved day case rate (OR, 3.5; 95% CI, 1.5–8.1; p = 0.005; Fig.…”

Section: Resultsmentioning

confidence: 99%

“…2 , 3 , 4 , 5 Implementation of standard clinical pathways for LC have been reported to successfully reduce LOS and increase day case success. 6 , 7 , 8 , 9 , 10 , 11 , 12 Day case laparoscopic cholecystectomy (DCLC) is associated with cost-savings 3 , 13 , 14 without increasing the risk of adverse events or readmissions. 3 , 15 , 16 It has a high rate of patient satisfaction 17 , 18 and is comparable with inpatient stay with respect to quality of life, return to work and normal activity.…”

Section: Introductionmentioning

confidence: 99%

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Systematic review and meta-analysis of factors which reduce the length of stay associated with elective laparoscopic cholecystectomy

Ryan

OʼConnell

Rogers

et al. 2021

HPB

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Background Laparoscopic cholecystectomy is a safe ambulatory procedure in appropriately selected patients; however, day case rates remain low. The objective of this systematic review and meta-analysis was to identify interventions which are effective in reducing the length of stay (LOS) or improving the day case rate for elective laparoscopic cholecystectomy. Methods Comparative English-language studies describing perioperative interventions applicable to elective laparoscopic cholecystectomy in adult patients and their impact on LOS or day case rate were included. Results Quantitative data were available for meta-analysis from 80 studies of 10,615 patients. There were an additional 17 studies included for systematic review. The included studies evaluated 14 peri-operative interventions. Implementation of a formal day case care pathway was associated with a significantly shorter LOS (MD = 24.9 h, 95% CI, 18.7–31.2, p < 0.001) and an improved day case rate (OR = 3.5; 95% CI, 1.5–8.1, p = 0.005). Use of non-steroidal anti-inflammatories, dexamethasone and prophylactic antibiotics were associated with smaller reductions in LOS. Conclusion Care pathway implementation demonstrated a significant impact on LOS and day case rates. A limited effect was noted for smaller independent interventions. In order to achieve optimal day case targets, a greater understanding of the effective elements of a care pathway and local barriers to implementation is required.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis of factors which reduce the length of stay associated with elective laparoscopic cholecystectomy

Ryan

OʼConnell

Rogers

et al. 2021

HPB

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“…The strict use of an effective postoperative scoring system could be one method implemented at YG and LLGH to increase the proportion of successful DCLCs. The 'Chung Score' suggested by Greilsamer et al (2018) is a post-anaesthetic discharge criteria that evaluates patients' fitness following day-case surgery (Daradkeh et al 1998). Its use has shown to significantly increase the success of outpatient DCLCs by providing a clear, succinct pathway towards safe and appropriate discharge (Greilsamer et al 2018, Randhawa & Pujahari 2009.The current surgical day-case wards at YG and LLGH follow a discharge criterion with some similarities to the Chung Score (such as postoperative mobility, nausea/vomiting and pain).…”

Section: Further Workmentioning

confidence: 99%

“…As LC is one of the first procedures performed by surgical trainees (Greilsamer et al 2018), surgeon experience for the failed DCLCs at YG and LLGH may provide insight and reasoning behind intra/ postoperative complications, conversions to open LC and readmissions seen. Although operation times are longer in LCs performed by trainees compared to consultant level surgeons, Atta et al suggests no differences in complication rates when trainees are observed by their seniors (Atta et al 2017, Greilsamer et al 2018. Investigation into LC operation waiting times after acute cholecystitis presentation or following ERCP would also benefit practice by creating an optimum time frame for these patients selected for LC surgery at LLGH isolated day unit.…”

Section: Further Workmentioning

confidence: 99%

Day case laparoscopic cholecystectomy: Identifying patients for a ‘COVID-Cold’ isolated day-case unit during the pandemic

Hinchcliffe

Imran

Lala

2021

Journal of Perioperative Practice

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Background The UK practice of laparoscopic cholecystectomy has reduced during the COVID-19 pandemic due to cancellation of non-urgent operations. Isolated day-case units have been recommended as ‘COVID-cold’ operating sites to resume surgical procedures. This study aims to identify patients suitable for day case laparoscopic cholecystectomy (DCLC) at isolated units by investigating patient factors and unexpected admission. Method Retrospective analysis of 327 patients undergoing DCLC between January and December 2018 at Ysbyty Gwynedd (District General Hospital; YG) and Llandudno General Hospital (isolated unit; LLGH), North Wales, UK. Results The results showed that 100% of DCLCs in LLGH were successful; 71.4% of elective DCLCs were successful at YG. Increasing age ( p = 0.004), BMI ( p = 0.01), ASA Score ( p = 0.006), previous ERCP ( p = 0.05), imaging suggesting cholecystitis ( p = 0.003) and thick-walled gallbladder ( p = 0.04) were significantly associated with failed DCLC on univariate analysis. Factors retaining significance (OR, 95% CI) after multiple regression include BMI (1.82, 1.05–3.16; p = 0.034), imaging suggesting cholecystitis (4.42, 1.72–11.38; p = 0.002) and previous ERCP (5.25, 1.53–18.00; p = 0.008). Postoperative complications are comparable in BMI <35kg/m2 and 35–39.9kg/m2. Conclusions Current patient selection for isolated day unit is effective in ensuring safe discharge and could be further developed with greater consideration for patients with BMI 35–39.9kg/m2. As surgical services return, this helps identify patients suitable for laparoscopic cholecystectomy at isolated COVID-free day units.

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“…6,7 For example in laparoscopic cholecystectomy, this even led to successful twenty-four hours discharge for 96% of patients and reduced length of stay for this entire patient population. [8][9][10][11][12][13] This was cost-effective and increased bed capacity without increased readmission rates. 9,12,14 These benefits are important considering the increasing healthcare costs worldwide.…”

Section: Introductionmentioning

confidence: 99%

Twenty-four Hours Stay After Colorectal Surgery; A Systematic Review

Smalbroek,

Schuffel,

Weijs

et al. 2023

Journal of Coloproctology

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Introduction The introduction of Enhanced Recovery After Surgery led to increasing twenty-four hours discharge pathways, for example in laparoscopic cholecystectomy and bariatric surgery. However, implementation in colorectal surgery still must set off. This systematic review assesses safety and feasibility of twenty-four hours discharge in colorectal surgery in terms of readmission and complications in current literature. Secondary outcome was identification of factors associated with success of twenty-four hours discharge. Methods Pubmed and EMBASE databases were searched to identify studies investigating twenty-four hours discharge in colorectal surgery, without restriction of study type. Search strategy included keywords relating to ambulatory management and colorectal surgery. Studies were scored according to MINORS score. Results Thirteen studies were included in this systematic review, consisting of six prospective and seven retrospective studies. Number of participants of the included prospective studies ranged from 5 to 157. Median success of discharge was 96% in the twenty-four hours discharge group. All prospective studies showed similar readmission and complication rates between twenty-four hours discharge and conventional postoperative management. Factors associated with success of twenty-four hours discharge were low ASA classification, younger age, minimally invasive approach, and relatively shorter operation time. Conclusions Twenty-four hours discharge in colorectal surgery seems feasible and safe, based on retro- and prospective studies. Careful selection of patients and establishment of a clear and adequate protocol are key items to assure safety and feasibility. Results should be interpreted with caution, due to heterogeneity. To confirm results, an adequately powered prospective randomized study is needed.

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Increasing success in outpatient laparoscopic cholecystectomy by an optimal clinical pathway

Abstract: Optimal clinical pathway (more convincing and reassuring remarks in the preoperative consult and a dedicated outpatient facility) is the key to increase success in outpatient laparoscopic cholecystectomy.

Cited by 6 publications

References 13 publications

Systematic review and meta-analysis of factors which reduce the length of stay associated with elective laparoscopic cholecystectomy

Systematic review and meta-analysis of factors which reduce the length of stay associated with elective laparoscopic cholecystectomy

Day case laparoscopic cholecystectomy: Identifying patients for a ‘COVID-Cold’ isolated day-case unit during the pandemic

Twenty-four Hours Stay After Colorectal Surgery; A Systematic Review

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