Analysis of delayed discharge after day-surgery laparoscopic cholecystectomy

Junning Cao; Bo Liu; Xiangjun Li; Jianjun Leng; Xiangfei Meng; Yingwei Pan; Songmeng Dou; Shichun Lu

doi:10.1016/j.ijsu.2017.02.055

Analysis of delayed discharge after day-surgery laparoscopic cholecystectomy

Int J Surg. 2017 Apr:40:33-37. doi: 10.1016/j.ijsu.2017.02.055. Epub 2017 Feb 21.

Authors

Junning Cao¹, Bo Liu², Xiangjun Li¹, Jianjun Leng¹, Xiangfei Meng¹, Yingwei Pan¹, Songmeng Dou¹, Shichun Lu¹

Affiliations

¹ Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian, Beijing 100853, China.
² Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian, Beijing 100853, China. Electronic address: jnliubo@sohu.com.

PMID: 28235668
DOI: 10.1016/j.ijsu.2017.02.055

Abstract

Background: Delayed discharge is the existing obstacle to further enhancing quality of recovery after Day-surgery laparoscopic cholecystectomy (LC/DS). This study aims to analyze the reasons for delayed discharge after LC/DS.

Methods: The 745 patients with delayed discharge after LC/DS were retrospectively studied. The reasons for delayed discharge and data related to patients were collected and analyzed. Psychosocial reasons were defined by meeting discharge criteria but refusing to discharge, and complications were defined and graded using the "Clavien-Dindo" classification system. Differences were statistically significant when p-value < 0.01 level.

Results: The reasons for delayed discharge included psychosocial reasons (P, n = 324), conversion to open surgery (CO, n = 21) and Clavien-Dindo I (n = 72), II (n = 307), IIIa (n = 17), IVa (n = 4) complications. Group P had a shorter length of postoperative hospital stay (PHT) compared to groups I, II, IIIa, IVa and CO (p < 0.01, respectively). Group II had a longer operation time (p < 0.01) but no longer length of PHT (p = 0.814) compared to group I. The length of PHT in group IIIa was longer than that in groups I and II (p < 0.01, respectively), but the length of PHT in group IVa was no longer than that in groups I, II, and IIIa (p = 0.047, p = 0.044 and p = 0.849, respectively). Group CO had a longer operation time (p < 0.01, respectively), a more blood loss (p < 0.01, respectively) and a longer length of PHT (p < 0.01, respectively) compared to groups P, I, II, and IIIa.

Conclusion: Patients who are delayed discharge due to psychosocial reasons have a rapid postoperative recovery. The slower postoperative recovery and upgraded complication classifications are related and optimized medical procedures promote the recovery. It is reasonable for patients who undergo conversion to open surgery to experience a slow postoperative recovery.

Keywords: Day surgery; Delayed discharge; Laparoscopic cholecystectomy; Reason; “Clavien-Dindo” classification.

MeSH terms

Adult
Aged
Ambulatory Surgical Procedures / methods
Ambulatory Surgical Procedures / statistics & numerical data*
Cholecystectomy, Laparoscopic / methods
Cholecystectomy, Laparoscopic / statistics & numerical data*
Conversion to Open Surgery / statistics & numerical data
Female
Humans
Length of Stay
Male
Middle Aged
Operative Time
Patient Discharge / statistics & numerical data*
Postoperative Complications / classification*
Postoperative Complications / etiology
Postoperative Complications / psychology
Postoperative Period
Retrospective Studies
Time Factors