388 “Day Case Laparoscopic Cholecystectomy – Are We Getting It Right?”
L Zeng, S Joglekar- Surgery
Abstract
Introduction
About 66,660 cholecystectomies are performed in the UK annually, of which majority are laparoscopic, costing NHS about £ 111 million. As per GIRFT, 80% eligible patients should have cholecystectomy within 8 days of hospital admission. Cholecystectomy quality improvement collaborative was established nationwide to support surgical teams and improve patient outcomes. At our hospital, we have established a twice weekly HOT LAP CHOLE list to manage these patients.
Aim
To analyze outcomes after day case laparoscopic cholecystectomy.
Method
Records of 100 patients over 3 months undergoing elective or emergency cholecystectomy were retrospectively analyzed. Data collection included demographics, diagnosis, length of stay (LOS), complications, conversion rate, and re-admission rate.
Results
Among 100 cases (26 males, 74 females, with an age range of 22 – 89), 80 were elective and 20 were emergency. All emergency cases were operated on within 8 days of hospital admission. 73 were successfully performed as day cases (69 elective, 4 emergency), making the elective day-case rate 86%. LOS ranged from 1 to 34 days, and the reason of stay was mainly post-op pain/vomiting or drain left intraoperatively. 3 cases were converted to open (2 electives, 1 emergency). The re-admission rate was 6% (4 electives, 2 emergencies), mainly because of post-operative pain. 9 patients had complications (3 - bleeding, 5 - bile leak, 1 - wound infection).
Conclusions
The successful day-case rate meets the recommendation by the British Association of Day Case Surgery (> = 60%). And our HOT LAP CHOLE list has effectively improved the management of emergency cholecystectomy. However, post-op pain control should be optimized.