Timing of unplanned admission following daycare laparoscopic cholecystectomy.

BACKGROUND: Outpatient laparoscopic cholecystectomy is the treatment of choice for symptomatic biliary colic. There is controversy regarding the optimal candidate, and postoperative observation time for patients receiving daycare laparoscopic cholecystectomy.

METHODS: A retrospective, multi-centred, case-control chart review was performed from January 1, 2009 to December 31, 2011 on consecutive patients undergoing planned laparoscopic cholecystectomy. Patient demographics, surgical details, and postoperative details were analyzed.

RESULTS: 1256 daycare laparoscopic cholecystectomies were performed. One-hundred and twenty-one (9.6%) required unplanned admission the day of surgery. Forty (3.2%) were re-admitted within one month of surgery. The median time from surgical procedure to unplanned day of surgery admission was 218 min ± 143. The unplanned admission patients were older (54.6 vs 45.1, p < 0.005), and had ASA scores 3 or higher (24% vs 3%, p < 0.005). Comorbid conditions associated with unplanned admissions included hypertension, cardiac conditions, and chronic pain.

CONCLUSIONS: The majority of patients can be successfully managed with daycare laparoscopic cholecystectomy. A median time of 4 h is sufficient for postoperative observation. Risk factors for unplanned admission include age, ASA, hypertension, diabetes, and chronic pain.