Reducing Unplanned Hospital Admissions Following Outpatient Laparoscopic Cholecystectomy

The most common factors for unplanned admission following outpatient laparoscopic cholecystectomy are surgical observations, pain, and postoperative and post-discharge nausea and vomiting (PONV), according to results of a retrospective study presented at the 2014 Annual Meeting of the American Society of Anesthesiologists (ASA).

Careful selection of patients, increased use of anaesthesia techniques, and more aggressive pain control may help to reduce these admissions, stated lead author Deepak Subramanian, MBChB, MD, Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom.

Outpatient laparoscopic cholecystectomy is a safe alternative to planned overnight admission, with no difference in morbidity, admission rate, pain, postoperative quality of life, patient satisfaction, or time to return to work. As more cholecystectomies are performed on an outpatient basis, however, it is important that the number of unplanned admissions does not increase.

Dr. Subramanian and colleagues wished to determine whether outpatient surgery services could be improved by adjusting clinical strategies. The researchers audited admissions at their facility over a period of 3 years after outpatient laparoscopic cholecystectomy. The data collected at the time of admission were analysed to learn why the patients returned after surgery. The researchers classified these reasons as “surgical,” “anaesthetic,” or “other.”

Their team examined data from 618 outpatient laparoscopic cholecystectomies performed over the 3-year period. Of these, 40 patients (6.4%) were admitted, with 21 patients (52.5%) admitted due to anaesthesia problems, and18 patients (45%) due to surgical reasons. One patient (7.5%) suffered both an anaesthetic and surgical complication. Admission rates (6.4%) in this study were lower than the 8.6% from a previous audit covering a shorter period of 23 months.

The researchers concluded that high-volume surgeons with regular outpatient surgery lists have lower admission rates. Unplanned admissions following outpatient surgery occur for reasons that include surgical skill, quality of clinical work, choice of surgical procedure, effectiveness of pre-assessment, and protocol for handling postoperative recovery problems.

Dr. Subramanian noted that recent admission rates may have fallen because of more aggressive management of postoperative problems.