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Observational Study
. 2023 Oct 1;33(5):463-473.
doi: 10.1097/SLE.0000000000001207.

A Prospective Cohort Analysis of the Prevalence and Predictive Factors of Delayed Discharge After Laparoscopic Cholecystectomy in Italy: The DeDiLaCo Study

Nicola Cillara  1 , Mauro Podda  2 , Enrico Cicalò  3 , Giovanni Sotgiu  4 , Maria Provenzano  1 , Pietro Fransvea  5 , Gaetano Poillucci  6 , Raffaele Sechi  1 ; DeDiLaCo Study Collaborative Group
Collaborators, Affiliations
Observational Study

A Prospective Cohort Analysis of the Prevalence and Predictive Factors of Delayed Discharge After Laparoscopic Cholecystectomy in Italy: The DeDiLaCo Study

Nicola Cillara et al. Surg Laparosc Endosc Percutan Tech. .

Abstract

Background: The concept of early discharge ≤24 hours after Laparoscopic Cholecystectomy (LC) is still doubted in Italy. This prospective multicentre study aims to analyze the prevalence of patients undergoing elective LC who experienced a delayed discharge >24 hours in an extensive Italian national database and identify potential limiting factors of early discharge after LC.

Methods: This is a prospective observational multicentre study performed from January 1, 2021 to December 31, 2021 by 90 Italian surgical units.

Results: A total of 4664 patients were included in the study. Clinical reasons were found only for 850 patients (37.7%) discharged >24 hours after LC. After excluding patients with nonclinical reasons for delayed discharge >24 hours, 2 groups based on the length of hospitalization were created: the Early group (≤24 h; 2414 patients, 73.9%) and the Delayed group (>24 h; 850 patients, 26.1%). At the multivariate analysis, ASA III class ( P <0.0001), Charlson's Comorbidity Index (P=0.001), history of choledocholithiasis (P=0.03), presence of peritoneal adhesions (P<0.0001), operative time >60 min (P<0.0001), drain placement (P<0.0001), pain ( P =0.001), postoperative vomiting (P=0.001) and complications (P<0.0001) were independent predictors of delayed discharge >24 hours.

Conclusions: The majority of delayed discharges >24 hours after LC in our study were unrelated to the surgery itself. ASA class >II, advanced comorbidity, the presence of peritoneal adhesions, prolonged operative time, and placement of abdominal drainage were intraoperative variables independently associated with failure of early discharge.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
DeDiLaCo study flow diagram.
FIGURE 2
FIGURE 2
The area under the ROC curve. Analysis of the predictive model of delayed discharge >24 hours after LC. [Area Under ROC curve(AUC), 0.87, 95% CI 0.85–0.88, Hosmer-Lemeshow test P=0.96].
See this image and copyright information in PMC

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