1211 Review of the Factors Leading to an Unplanned Inpatient Stay Following a Day Case Laparoscopic Cholecystectomy in a Tertiary Centre

Aim

To review the factors responsible for an unplanned Inpatient Stay (IPS) following a day case Laparoscopic Cholecystectomy (LC).

To develop strategies preventing unnecessary hospital stays after Day Case LC.

Method

We retrospectively collected data on all the LC performed in a Tertiary Centre over 3 months (January – March 2022).

Results

162 patients underwent LC during this period; 135 (83.3%) patients were planned day cases out of which 68/135 (50.37%) had an IPS and 67/135 (49.62%) were same-day discharges (SDD). 27/162 (16.66%) patients had emergency LC. 54% n = 37 LC performed in the afternoon had IPS compared to 14% n = 10 among the SDD [p<0.0001]. 47% n = 32 In-patient LC performed by non-consultant grade compared to 32% n = 22 among the SDD.

7% n = 5 IP due to social issues, 10% n = 7 no documented IP causes identified and 4% n = 3 had booking error, booked as Inpatient despite the patient having SDD. Other identified causes were drain Insertion (9% n = 6), longer operations (n = 1; mean operation time 92 min IP vs 82 min SDD) and late recovery (9% n = 6).

Conclusions

The rate of an unplanned overnight stay was found to be significantly high (50.37%, n = 135). Several human factors such as errors in the booking proforma, late-afternoon lists, and no clear discharge planning in the post-op notes were among the few factors which could easily be improved. A review of these factors is deemed necessary not only for improving patient outcomes & quality of care but equally for reducing healthcare costs.