Is outpatient cholecystectomy safe for the higher-risk elective patient?

Abstract

Outpatient cholecystectomy is safe for the higher-risk patient. Patients who recover uneventfully from surgery can be discharged without harmful effects. "Precautionary" hospitalization may be harmful.

Randomized clinical trial of day-careversusovernight-stay laparoscopic cholecystectomy

“…Eventually patients with some degree of co-morbidity are included and some centres have reported routine LC without specific patient selection, at the cost of a higher admission rate 20 -22 . Outpatient LC has been demonstrated to be safe even for older and high-risk (ASA grade III) patients undergoing elective operations 23 . On the other hand, in one North American study, a previous diagnosis of acute cholecystitis or biliary pancreatitis was highly predictive of hospital admission and patients with an ASA grade of more than II were more likely to require a postoperative stay of over 12 h 24 .…”

Predictors of improvement in health-related quality of life in patients undergoing cholecystectomy

“…For example, patients who have asymptomatic cholelithiasis may not benefit from cholecystectomy or even have a negative benefit to risk ratio given the potential for surgical complications. Most studies have attempted to address this issue by examining clinical outcomes 3 , specific diagnostic features such as cholecystitis 4 , specific patient populations such as elderly or high-risk patients 5,6 , or rates of conversion from laparoscopic to open surgery 7 .…”

Outpatient Laparoscopic Cholecystectomy: Patient Outcomes After Implementation of a Clinical Pathway

“…Our data reflect those from other studies, confirming the feasibility and safety of outpatient LC in unselected patients, 4,7,10 including those older than 70 or with comorbidities. 16 Several patients were excluded from pathway participation before surgery by their surgeon on the basis of comorbidities; no patient was excluded during the last 3 months of the study. Despite reports in the literature indicating the safety of outpatient surgery in these patients, this suggests that surgeon or institutional experience leading to a comfort level with these patients is an important factor in the successful completion of LC as an outpatient procedure.…”