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

Abstract

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.

Differences in Postoperative Pain, Nausea, and Vomiting After Elective Laparoscopic Cholecystectomy in Premenopausal and Postmenopausal Mexican Women

“…Thus, about 30% of patients undergoing surgical intervention present with PONV, which although these symptoms are to be expected continues to be a reason for lengthening hospital stays and, more importantly, discomfort in patients [4, 5]. The incidence of postoperative pain is reported to be 46–72% [6], and this level persists despite recent advances in understanding its pathophysiology, the advent of analgesics and potent antiemetics, as well as technical refinements in the LC procedure [7].…”

Chronological trends in patients undergoing cholecystectomy in Korea: a nationwide health insurance claims study

“…In previous studies, the median LOS reported ranged between 2 days and 2.2 days [ 13 24 ]. Moreover, a recent meta-analysis that included 10,615 patients found that the mean LOS was 61.2 hours [ 25 ]. However, given that the hospitals enrolled in this meta-analysis were diverse and that the LOS can be affected by financial or organizational factors, differences may occur depending on hospital size and insurance coverage between countries.…”

Features of Laparoscopic Cholecystectomy in Special Groups of Patients

“…Based on data from clinical studies of the effect of pneumoperitoneal pressure reduction no difference observed in the average life expectancy of patients who underwent surgery with pressure ≤ 10 mm Hg and patients who were treated with a pressure of 10-15 mm Hg [24].…”