Can we consider day-case laparoscopic cholecystectomy for acute calculous cholecystitis? Identification of potentially eligible patients

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• 作者：David Fuks ; Cyril Cosse ; Charles Sabbagh ; Delphine Lignier ; Celine Degraeve ; Jean Marc Regimbeau
• 关键词：Acute cholecystitis ; Cholecystectomy ; Day-case surgery
• 刊名：Journal of Surgical Research
• 出版年：January, 2014
• 年：2014
• 卷：186
• 期：1
• 页码：142-149
• 全文大小：555 K

文摘

Background

Day-case laparoscopic cholecystectomy has not yet been validated for acute cholecystitis. We sought to identify a subgroup of acute cholecystitis patients having been hospitalized overnight after laparoscopic cholecystectomy but who could have been eligible for day-case surgery.

Methods

We identified patients treated for acute cholecystitis with laparoscopic cholecystectomy in our university medical center between May 1, 2010, and May 31, 2012, and who lacked contraindications for day-case surgery. In a second step, we assumed that patients hospitalized for <3 d would have been eligible for day-case surgery. We then compared patients hospitalized for 鈮? d with those hospitalized for >3 d in terms of demographic data, laboratory test results, and surgical procedures.

Results

The study population comprised 86 men and 82 women (median age: 57 y; age range: 18-90 y). Contraindications for day-case surgery were identified preoperatively in 23% of the cases (39 of 168) and intraoperatively in another 23% of the cases. The proportion of patients hospitalized for <3 d was 41% (69 of 168) when considering the intention-to-treat population and 57% (51 of 90) when considering patients with no contraindications to day-case surgery. Forty percent of the patients hospitalized for 鈮? d (16 of 39) suffered from postoperative pain that was poorly controlled by oral analgesics. Abdominal drainage was the only predictive factor for hospitalization <3 d (odds ratio [95% confidence interval] = 0.13 [0.02-0.71]; P = 0.01).

Conclusions

Day-case laparoscopic may be feasible in selected patients with mild or moderate acute calculous cholecystitis. Our present results may be of use in designing a study of day-case surgery for acute calculous cholecystitis and related changes in the management of these patients.