Hindrance to day care laparoscopic cholecystectomy in India

Abstract

Background: Laparoscopic cholecystectomy is considered “gold standard” for the treatment of gallstone disease. In spite of the increasing number of laparoscopic cholecystectomies being performed as day care surgery in the West, the surgeons of developing countries are reluctant to adopt this trend probably due to the inadequate resources and infrastructure which they consider a hindrance for safe discharge. Our study aims to assess the feasibility of day care laparoscopic cholecystectomies. Materials and methods: This is a prospective observational study. All patients undergoing laparoscopic cholecystectomy were assessed postoperatively for dischargeability using post-anesthetic discharge scoring system (PADSS). We assessed the factors delaying the early discharge of laparoscopic cholecystectomy patients in terms of patient factors, intraoperative factors, postoperative factors, social factors, and logistic factors. Results: Of the total 88 patients, 57 (64.7%) were dischargeable at 6 hours and 78 (88.6%) were dischargeable at 24 hours. Factors found to affect dischargeability of patients at 6 hours were acute cholecystitis and increased duration of surgery. Difficulty of surgery and the use of drain had significant association with nondischargeability at 24 hours. Eighteen patients were fit for discharge by PADSS criteria but not discharged at 24 hours. Factors, which delayed the discharge of these patients, were continuation of intravenous antibiotics, delay in processing insurance, patients’ unwillingness for early discharge, presence of drain, and surgeon’s perceived fear of complications. Conclusion: Sixty-five percent of all laparoscopic cholecystectomies can be performed as day care procedure safely. Patients with acute cholecystitis and patients requiring an operative time more than 104 minutes should be observed for 24 hours.