Single hospital visit elective day-case laparoscopic cholecystectomy without prior outpatient attendance

Abstract

Introduction: Eighty percent of all UK elective laparoscopic cholecystectomies (LC) are performed as day-case procedures, but the pre-operative patient pathway has received little attention. In response to local patient feedback, we aimed to introduce a single hospital visit pathway for day-case LC.

Methods: A single hospital visit pathway for elective LC was piloted alongside standard services. Following telephone consultation, a pack containing procedure information, knowledge questionnaire and consent form were sent. Patients were not excluded on age, BMI or co-morbidity criteria, but recent ultrasonography and liver function tests were required. Patients were operated without attending any clinic or pre-operative service. There was no restriction on surgical or anaesthetic technique. Early surgeon-led telephone follow-up was made post-operatively and patient satisfaction assessed at 3 months.

Results: One hundred and sixty-six patients were referred with 92% transferred to day-case waiting lists following telephone consultation. One hundred and six patients underwent LC without previously visiting the hospital with 85% discharged the same day. Nine percent required post-operative primary care review primarily for wound reviews. Median patient-reported time to normal activities was 4 weeks (range 1-12). Ninety-nine percent reported being satisfied with the single-stop pathway.

Conclusions: Single hospital visit LC is feasible, safe and acceptable for primary care referral patients with symptomatic gallstone disease without evidence of common bile duct or LFT abnormalities.

Keywords: Cholecystectomy; Day case; Laparoscopy; One stop; Single visit.