Increasing success in outpatient laparoscopic cholecystectomy by an optimal clinical pathway

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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.

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