Increasing success in outpatient laparoscopic cholecystectomy by an optimal clinical pathway

Abstract

Background: The objective of this study was to evaluate the impact of more convincing and reassuring remarks from the surgeon in the preoperative consult associated with a dedicated outpatient facility to increase our rate of success in outpatient laparoscopic cholecystectomy.

Methods: A one-centre prospective clinical study was conducted between February 2013 and May 2015. During the first time period (February 2013-March 2014), patients were hospitalized in conventional care unit and given the possibility to choose an outpatient procedure. In the second phase (April 2014-May 2015), the patients were held in a dedicated outpatient facility. Outpatient success rate was evaluated using Chung's discharge score 6 h after surgery.

Results: Eighty patients were included (30 in a traditional setting, 50 in an optimal clinical pathway). Both groups were comparable for mean age, American Society of Anesthesiologists score and mean operative time (P = 0.36, P = 1 and P = 0.09, respectively). Success in outpatient surgery was significantly higher in the optimal clinical pathway group (73.3% versus 96%, P = 0.005). The only criteria which was significantly improved in Chung score was perambulation (P = 0.001). There was no significant difference between the two groups for post-operative complications (P = 0.28) or readmission (P = 1).

Conclusion: Optimal clinical pathway (more convincing and reassuring remarks in the preoperative consult and a dedicated outpatient facility) is the key to increase success in outpatient laparoscopic cholecystectomy.

Keywords: general surgery; hepatopancreaticobiliary surgery.