Is standardized care feasible in the emergency setting? A case matched analysis of patients undergoing laparoscopic cholecystectomy

Fabian Grass; Matthieu Cachemaille; Catherine Blanc; Nicolas Fournier; Nermin Halkic; Nicolas Demartines; Martin Hübner

doi:10.1186/s12893-016-0194-6

Is standardized care feasible in the emergency setting? A case matched analysis of patients undergoing laparoscopic cholecystectomy

BMC Surg. 2016 Dec 1;16(1):78. doi: 10.1186/s12893-016-0194-6.

Authors

Fabian Grass¹, Matthieu Cachemaille², Catherine Blanc², Nicolas Fournier³, Nermin Halkic¹, Nicolas Demartines⁴, Martin Hübner¹

Affiliations

¹ Department of Visceral Surgery, University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland.
² Department of Anaesthesiology, University Hospital CHUV, Lausanne, Switzerland.
³ Institute for Social and Preventive Medicine, University Hospital CHUV, Lausanne, Switzerland.
⁴ Department of Visceral Surgery, University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland. demartines@chuv.ch.

Abstract

Background: Immediate laparoscopic cholecystectomy is the accepted standard for the treatment of acute cholecystitis. The aim of the present study was to evaluate the feasibility of a standardized approach with tailored care maps for pre- and postoperative care by comparing pain, nausea and patient satisfaction after elective and emergent laparoscopic cholecystectomy.

Methods: From January 2014 until April 2015, data on pain and nausea management were prospectively recorded for all elective and emergency procedures in the department of visceral surgery. This prospective observational study compared consecutive laparoscopic elective vs. emergency cholecystectomies. Visual analogue scales (VAS) were used to measure pain, nausea, and satisfaction from recovery room until 96 hours postoperatively.

Results: Final analysis included 168 (79%) elective cholecystectomies and 44 (21%) emergent procedures. Demographics (Age, gender, BMI and ASA-scores) were comparable between the 2 groups. In the emergency group, patients did not receive anxiolytic medication (0% vs.13%, p = 0.009) and less postoperative nausea and vomiting (PONV) prophylaxis (77% vs. 97% p = <0.001). Perioperative pain management was similar in terms of opioid consumption (median amount of fentanyl 450ug [IQR 350-500] vs. 450ug [375-550], p = 0.456) and wound infiltration rates (24% vs. 25%, p = 0.799). Postoperative consumption of paracetamol, metamizole and opiod medications were similar between the 2 groups. VAS scores for pain (p = 0.191) and nausea (p = 0.392) were low for both groups. Patient satisfaction was equally high in both clinical settings (VAS 8.5 ± 1.1 vs. 8.6 ± 1.1, p = 0.68).

Conclusions: A standardized pathway allows equally successful control of pain and nausea after both elective and emergency laparoscopic cholecystectomy. This study was retrospectively registered by March 01, 2016 in the following trial register: www.researchregistry.com (UIN researchregistry993).

Keywords: Cholecystectomy; Elective; Emergent; Pain management; Postoperative.

Publication types

Comparative Study
Observational Study

MeSH terms

Adult
Aged
Cholecystectomy, Laparoscopic / standards*
Cholecystitis, Acute / surgery*
Critical Pathways
Elective Surgical Procedures / standards
Emergencies
Feasibility Studies
Female
Humans
Male
Middle Aged
Pain Measurement
Pain, Postoperative
Patient Satisfaction
Postoperative Nausea and Vomiting
Prospective Studies