Anubhav Vindal, MS, DNB, MRCSEd, FRCSGlas, FACS, FAIS, Saurav Kumar, MBBS, Pawanindra Lal, MS, DNB, FRCSEd, FRCSGlas, FACS, FAIS. Division of Minimal Access Surgery, Department of Surgery, Maulana Azad Medical College, New Delhi, India
Background: Day care laparoscopic cholecystectomy (DCLC) is increasingly replacing inpatient cholecystectomy in the developed nations. Early mobilization and return to normal activities has many positive implications for the patient, the hospital, and society. However, the safety and efficacy of DCLC is yet to be tested in developing nations especially in centres without dedicated units and well-established protocols for day care surgery.
We present the results of our prospective randomized double blind study to evaluate feasibility and safety of DCLC in unselected patients in a tertiary care university hospital of a developing country without a separate facility for day care surgery.
Methods and Procedures: Hundred patients of symptomatic gall stone disease planned for elective LC were included in the study. The only selection criteria that were used to screen the patients were residence within 1 hour of travel time to the hospital, ability to comprehend written, verbal and telephonic instructions and a responsible adult company at home.
The patients were randomized at the conclusion of the surgery into two groups of 50 patients each (DCLC and in-patient LC). The surgeon and the observer were blinded to the groups of the patients.
Post-operative pain (at 6, 12, 24 hours and 1 week) (using VAS), time of return to activities and patient satisfaction (using Capuzzo score) were recorded and compared between the two groups. Discharge and readmission rates were also recorded in the DCLC group.
Results: The mean VAS at 6, 12, 24 hours and 1 week was more or less similar in the two groups (p=0.637, 0.612, 0.582 and 0.536 respectively). However the mean time to return to activities was significantly lower (p<0.0001) and mean Capuzzo score (patient satisfaction) higher (p<0.05) in DCLC group compared to in-patient LC group. The discharge rate for the DCLC group was 98% (49/50 patients discharged as planned). There were no readmissions in this group (0%).
Conclusions: DCLC is safe and feasible in unselected patients even in centres without dedicated day care units. Proper patient counselling and adherence to standard discharge protocols may help in reducing readmission rates and increasing patient satisfaction and acceptability of this pathway. Developing countries have a lot to gain from day care approach, in the form of decreased health care costs, higher turnover of hospital beds, and decreased loss of work days.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94063
Program Number: P249
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster