Safety of ambulatory laparoscopic cholecystectomy in the elderly

Abstract

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.

The effect of ultrasound-guided low serratus anterior plane block on laparoscopic cholecystectomy postoperative analgesia

“…LC has now become a routine operation and is also the preferred method for the treatment of benign gallbladder diseases [8] . In order to speed up hospital bed turnover and reduce the medical and economic burden of patients, many hospitals have begun to try to perform LC in day wards [9] .…”

“…LC has now become a routine operation and is also the preferred method for the treatment of benign gallbladder diseases. [8] In order to speed up hospital bed turnover and reduce the medical and economic burden of patients, many hospitals have begun to try to perform LC in day wards. [9] However, the early pain postcholecystectomy seriously affects the recovery of patients and even leads to patients to be transferred from the day ward to the ward for further treatment, [10] which is also contrary to the concept of accelerated rehabilitation surgery.…”