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A meta-analysis of ambulatory versus inpatient laparoscopic cholecystectomy

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Abstract

Background

Laparoscopic cholecystectomy is increasingly used on an ambulatory basis. This study aimed to examine its effectiveness for carefully selected patients.

Methods

A systematic review of Cochrane, Embase, and Medline using the keywords “ambulatory,” “laparoscopic,” and “cholecystectomy” was performed. Postoperative complications leading to admissions and readmissions were compared between day care and inpatient laparoscopic cholecystectomy groups. Postoperative quality of life, patient satisfaction, and cost effectiveness also were analyzed.

Results

The search process identified seven clinical trials suitable for meta-analysis. These trials, consisting of 598 patients, compared day care and inpatient procedures. The unplanned admission rate in the ambulatory group was comparable with the prolonged hospitalization of inpatients (odds ratio [OR], 1.979; 95% confidence interval [CI], 0.846–4.628). There was no significant difference between the readmission rates of the two groups (OR, 0.964; 95% CI, 0.318–2.922). The quality-of-life indicators were similar for the ambulatory and overnight-stay patients (p = 0.195). The cost effectiveness was better for the day care procedures because of the shorter mean hospital stay.

Conclusion

Ambulatory laparoscopic cholecystectomy can be performed safely for selected patients, with reduced cost and a high level of patient satisfaction.

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References

  1. Perissat J, Collet DR, Belliard R (1989) Gallstones: iaparoscopic treatment, intracorporeal lithotripsy followed by cholecystostomy or cholecystectomy: a personal technique. Endoscopy 21(Suppl 1):373–374

    PubMed  Google Scholar 

  2. Reddick EJ, Olsen DO (1990) Outpatient laparoscopic laser cholecystectomy. Am J Surg 160:485–487

    Article  PubMed  CAS  Google Scholar 

  3. Chauhan A, Mehrotra M, Bhatia PK, Baj B, Gupta AK (2006) Day care laparoscopic cholecystectomy: a feasibility study in a public health service hospital in a developing country. World J Surg 30:1690–1695

    Article  PubMed  CAS  Google Scholar 

  4. Wenner DE, Whitwam P, Turner D, Chadha A, Degani J (2006) Laparoscopic cholecystectomy and management of biliary tract stones in a freestanding ambulatory surgery centre. JSLS 10:47–51

    PubMed  Google Scholar 

  5. Skattum J, Edwin B, Trondsen W, Mjaland O, Raede J, Buanes T (2004) Outpatient laparoscopic surgery: feasibility and consequences for education and health care costs. Surg Endosc 18:796–801

    Article  PubMed  CAS  Google Scholar 

  6. Keulemans Y, Eshuis J, de Haes H, de Wit LT, Gouma DJ (1998) Laparoscopic cholecystectomy: day-care versus clinical observation. Ann Surg 228:734–740

    Article  PubMed  CAS  Google Scholar 

  7. Hollington P, Toogood GJ, Padbury RT (1999) A prospective randomized trial of day-stay only versus overnight-stay laparoscopic cholecystectomy. Aust N Z J Surg 69:841–843

    Article  PubMed  CAS  Google Scholar 

  8. Dirksen CD, Schmitz RF, Hans KM, Nieman FHM, Hoogenboom LJ, Go PMNYH (2001) Laparoscopic cholecystectomy in an ambulatory treatment is just as effective as an overnight stay and from a social perspective is cheaper: a randomised study. Ned Tijdschr Geneesk 145:2434–2439

    Google Scholar 

  9. Young J, O’Connell B (2001) Recovery following laparoscopic cholecystectomy in either a 23-h or an 8-h facility. J Qual Clin Pract 21:2–7

    Article  PubMed  CAS  Google Scholar 

  10. Curet MJ, Contreras M, Weber DM, Albrecht R (2002) Laparoscopic cholecystectomy: outpatient vs inpatient management. Surg Endosc 16:453–457

    Article  PubMed  CAS  Google Scholar 

  11. Sharma A, Hayden JD, Reese RA, Sedman PC, Royston CMS, O’Boyle CJ (2004) Prospective comparison of ambulatory with inpatient laparoscopic cholecystectomy: outcome, patient preference, and satisfaction. J Ambulatory Surg 11:23–26

    Article  Google Scholar 

  12. Johansson M, Thune A, Nelvin L, Lundell L (2006) Randomized clinical trial of day-care versus overnight-stay laparoscopic cholecystectomy. Br J Surg 93:40–45

    Article  PubMed  CAS  Google Scholar 

  13. Lau H, Brooks DC (2002) Transitions in laparoscopic cholecystectomy: the impact of ambulatory surgery. Surg Endosc 16:323–326

    Article  PubMed  CAS  Google Scholar 

  14. Lam D, Miranda R, Hom SJ (1997) Laparoscopic cholecystectomy as an outpatient procedure. J Am Coll Surg 185:152–155

    PubMed  CAS  Google Scholar 

  15. Voyles CR, Berch BR (1997) Selection criteria for laparoscopic cholecystectomy in an ambulatory care setting. Surg Endosc 11:1145–1146

    Article  PubMed  CAS  Google Scholar 

  16. Robinson TN, Biffl WL, Moore EE, Heimbach JK, Calkins CM, Burch JM (2002) Predicting failure of outpatient laparoscopic cholecystectomy. Am J Surg 184:515–519

    Article  Google Scholar 

  17. Metcalfe MS, Mullin EJ, Maddern GJ (2006) Relaxation of the criteria for day surgery laparoscopic cholecystectomy. ANZ J Surg 76:142–144

    Article  PubMed  Google Scholar 

  18. Voitk AJ (1997) Is outpatient cholecystectomy safe for the higher-risk elective patient? Surg Endosc 11:1147–1149

    Article  PubMed  CAS  Google Scholar 

  19. Fiorillo MA, Davidson PG, Fiorillo M et al (1996) 149 Ambulatory laparoscopic cholecystectomies. Surg Endosc 10:52–56

    Article  PubMed  CAS  Google Scholar 

  20. Mjaland O, Reader J, Aasboe V et al (1997) Outpatient laparoscopic cholecystectomy. Br J Surg 84:958–961

    Article  PubMed  CAS  Google Scholar 

  21. Leeder PC, Mathews T, Krzeminska K, Dehn TCB (2004) Routine day-case laparoscopic cholecystectomy. Br J Surg 91:312–316

    Article  PubMed  CAS  Google Scholar 

  22. Lillemoe KD, Lin JW, Talamini MA, Yeo CJ, Synder DS, Parker SD (1999) Laparoscopic cholecystectomy as a “true” outpatient procedure: initial experience in 130 consecutive patients. J Gastrointest Surg 3:44–49

    Article  PubMed  CAS  Google Scholar 

  23. Lau H, Brooks DC (2002) Contemporary outcomes of ambulatory laparoscopic cholecystectomy in a major teaching hospital. World J Surg 26:1117–1121

    Article  PubMed  Google Scholar 

  24. Yang H, Choi PT, McChesney J, Buckley N (2004) Induction with sevoflurane-remifentanil is comparable to propofol-fentanyl-rocuronium in PONV after laparoscopic surgery. Can J Anaesth 51:660–667

    PubMed  Google Scholar 

  25. Coloma M, White PF, Markowitz SD, Whitten CW, Macaluso AR, Berrisford SB, Thornton KC (2002) Dexamethasone in combination with dolasetron for prophylaxis in the ambulatory setting: effect on outcome after laparoscopic cholecystectomy. Anaesthesiology 96:1346–1350

    Article  CAS  Google Scholar 

  26. Liberman MA, Howe S, Lane M (2000) Ondansetron versus placebo for prophylaxis of nausea and vomiting in patients undergoing ambulatory laparoscopic cholecystectomy. Am J Surg 179:60–62

    Google Scholar 

  27. Parlow JL, Meikle AT, van Vlymen J, Avery N (1999) Postdischarge nausea and vomiting after ambulatory laparoscopy is not reduced by promethazine prophylaxis. Can J Anaesth 46:719–724

    PubMed  CAS  Google Scholar 

  28. Reader JC, Mjaland O, Aasbo V, Grogaard B, Buanes T (1998) Desflurane versus propofol maintenance for outpatient laparoscopic cholecystectomy. Acta Anaesthesiol Scand 42:106–110

    Google Scholar 

  29. McGrath B, Elgendy H, Chung F, Kamming D, Curti B, King S (2004) Thirty percent of patients have moderate to severe pain 24 h after ambulatory surgery: a survey of 5,703 patients. Can J Anaesth 51:886–891

    PubMed  Google Scholar 

  30. Chung F, Tong D, Miceli PC, Reiz J, Harsanyi Z, Darke AC, Payne LW (2004) Controlled-release codeine is equivalent to acetaminophen plus codeine for postcholecystectomy analgesia. Can J Anaesth 51:216–221

    PubMed  Google Scholar 

  31. Michaloliakou C, Chung F, Sharma S (1996) Preoperative multimodal analgesia facilitates recovery after ambulatory laparoscopic cholecystectomy. Anesth Analg 82:44–51

    Article  PubMed  CAS  Google Scholar 

  32. Wilson YG, Rhodes M, Ahmed R, Daugherty M, Cawthorn SJ, Armstrong CP (1994) Intramuscular diclofenac sodium for postoperative analgesia after laparoscopic cholecystectomy: a randomised, controlled trial. Surg Laparosc Endosc 4:340–344

    PubMed  CAS  Google Scholar 

  33. Tsimoyiannis EC, Glantzounis G, Lekkas ET, Siakas P, Jabarin M, Tzourou H (1998) Intraperitoneal normal saline and bupivacaine infusion for reduction of postoperative pain after laparoscopic cholecystectomy. Surg Laparosc Endosc 8:416–420

    Article  PubMed  CAS  Google Scholar 

  34. O’Hanlon DM, Colbert S, Ragheb J, McEntee GP, Chambers F, Moriarty DC (2004) Intraperitoneal pethidine versus intramuscular pethidine for the relief of pain after laparoscopic cholecystectomy: randomized trial. Can J Anaesth 51:216–221

    Article  Google Scholar 

  35. Johnston SM, Kidney S, Sweeney KJ, Zaki A, Tanner WA, Keane FV (2003) Changing trends in the management of gallstone disease. Surg Endosc 17:781–786. Epub 2003 Feb 17

    Article  PubMed  CAS  Google Scholar 

  36. Narain PK, DeMaria EJ (1997) Initial results of a prospective trial of outpatient laparoscopic cholecystectomy. Surg Endosc 11:1091–1094

    Article  PubMed  CAS  Google Scholar 

  37. Zegarra RF II, Saba AK, Peschiera JL (1997) Outpatient laparoscopic cholecystectomy: safe and cost effective? Surg Laparosc Endosc 7:487–490

    Article  PubMed  Google Scholar 

  38. Critchlow JT, Paugh LM (1999) Is 24-h observation necessary after elective laparoscopic cholecystectomy? South Med J 92:1089–1092

    Article  PubMed  CAS  Google Scholar 

  39. Rosen MJ, Malm JA, Tarnoff M, Zuccala K, Ponsky JL (2001) Cost effectiveness of ambulatory laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 11:182–184

    Article  PubMed  CAS  Google Scholar 

  40. Vuilleumier H, Halkic N (2004) Laparoscopic cholecystectomy as a day surgery procedure: implementation and audit of 136 consecutive cases in a university hospital. World J Surg 28:737–740. Epub 2004 Aug

    Article  PubMed  Google Scholar 

  41. Blatt A, Chen S (2003) Day-only laparoscopic cholecystectomy in a regional teaching hospital. ANZ J Surg 73:321–325

    Article  PubMed  Google Scholar 

  42. Fassiadis N, Pepas L, Grandy-Smith S, Paix A, EI-Hasani S (2004) Outcome and patient acceptance of outpatient laparoscopic cholecystectomy. JSLS 8:251–343

    PubMed  Google Scholar 

  43. Ammori BJ, Davides D, Vezakis A, Martin IG, Larvin M, Smith S, Gibson JS, McMahon MJ (2003) Day-case laparoscopic cholecystectomy: a prospective evaluation of a experience. J Hepatobiliary Pancreat Surg 10:303–308

    Article  PubMed  Google Scholar 

  44. Siu WT, Leong HT, Law BK, Onsiong SM, Fung KH, Li AC, Tai YP, Li MK (2001) Outpatient laparoscopic cholecystectomy in Hong Kong: patient acceptance. Surg Laparosc Endosc Percutan Tech 11:92–96

    Article  PubMed  CAS  Google Scholar 

  45. Richardson WS, Fuhrman GS, Burch E, Bolton JS, Bowen JC (2001) Outpatient laparoscopic cholecystectomy in Hong Kong: patient acceptance. Surg Endosc 15:193–195

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Midwestern Regional Hospital, Ennis, Co Clare, Republic of Ireland

    N. Z. Ahmad, G. Byrnes & S. A. Naqvi

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  1. N. Z. Ahmad
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  2. G. Byrnes
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  3. S. A. Naqvi
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Correspondence to N. Z. Ahmad.

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Ahmad, N.Z., Byrnes, G. & Naqvi, S.A. A meta-analysis of ambulatory versus inpatient laparoscopic cholecystectomy. Surg Endosc 22, 1928–1934 (2008). https://doi.org/10.1007/s00464-008-9867-2

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