Cholecystectomy – a move to successful and safe day case surgery.

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Introduction

In September 2011 the Mater Hospital, Belfast, changed its practice for elective laparoscopic cholecystectomy (LC) to favour day surgery.

Aims

To evaluate if changing to day-case surgery was a safe and effective practice and to highlight areas to further improve this service.

Methods

In this retrospective study we identified all elective cholecystectomies planned as laparoscopic cases, admitted to the Elective Surgical Unit, within a 3-month period, in 3 successive years.

Results

From 1st April-30th June 2011; 62 cholecystectomies were performed. 9.7% were completed as day-cases without any readmissions. Of those not completed as day cases 83.9% were completed laparoscopically with an average admission lasting 1.96 days and a readmission rate of 7.7%. Readmission occurred at an average of day 5 post-operatively, with an average admission lasting 2 days. In the same time period in 2012 and 2013, after implementation of a definitive day surgery pathway; 91 and 87 cholecystectomies were performed with the day-case rate rising to 60.4% and 85.1% respectively. Readmission rates for day-cases were 7.3% and 10.8%, with the average time of readmission occurring at day 6.3 post-operatively for both years and an average admission lasting 2.8 and 5.4 days respectively.

Conclusion

Moving to day-case surgery has been safe and highly successful, yielding an increase in LC day-cases from 9.7% to 85.1% within 2 years. Readmission rates are similar between those previously admitted for surgery and those completed as day-cases. We attribute this success to clear clinical leadership, anaesthetic technique, staff education, nurse-led discharge, and managing patient expectations/education.