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Picard L, Duceau B, Cambriel A, Voron T, Makoudi S, Tsai AS, Yazid L, Soulier A, Paugam C, Lescot T, Bonnet F, Verdonk F. Risk factors for prolonged time to hospital discharge after ambulatory cholecystectomy under general anaesthesia. A retrospective cohort study. Int J Surg 2022; 104:106706. [PMID: 35697325 DOI: 10.1016/j.ijsu.2022.106706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although predictive models have already integrated demographic factors and comorbidities as risk factors for a prolonged hospital stay, factors related to anaesthesia management in ambulatory surgery have not been yet characterized. This study aims to identify anaesthetic factors associated with a prolonged discharge time in ambulatory surgery. METHODS All clinical records of patients who underwent ambulatory cholecystectomy in a French University Hospital (Hôpital Saint Antoine, Paris) between January 1st, 2012 and December 31st, 2018 were retrospectively reviewed. The primary endpoint was the discharge time, defined as the time between the end of surgery and discharge. A multivariable Cox proportional-hazards model was fitted to investigate the factors associated with a prolonged discharge time. RESULTS Five hundred and thirty-five (535) patients were included. The median time for discharge was 150 min (interquartile range - IQR [129-192]). A bivariable analysis highlighted a positive correlation between discharge timeline and the doses-weight of ketamine and sufentanil. In the multivariable Cox proportional hazards model analysis, the anaesthesia-related factors independently associated with prolonged discharge time were the dose-weight of ketamine in interaction with the dose weight of sufentanil (HR 0.10 per increment of 0.1 mg/kg of ketamine or 0.2 μg/kg of sufentanil, CI 95% [0.01-0.61], p = 0.013) and the non-use of a non-steroidal anti-inflammatory drug (NSAID) (HR 0.81 [0.67-0.98], p = 0.034). Twenty patients (4%) had unscheduled hospitalization following surgery. CONCLUSION Anaesthesia management, namely the use of ketamine and the non-use of NSAID, affects time to hospital discharge.
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Affiliation(s)
- Lucile Picard
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Baptiste Duceau
- Department of Anaesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière University Hospital, Sorbonne University, Public Hospitals of Paris (AP-HP), 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Amélie Cambriel
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thibault Voron
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Saint Antoine University Hospital, Department of Digestive Surgery, Paris, France
| | - Sarah Makoudi
- Department of Anesthesiology, Hôpital Saint Joseph, Groupe Hospitalier Paris Saint Joseph, 75014, Paris, France
| | - Amy S Tsai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, USA
| | - Lassaad Yazid
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Soulier
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Charles Paugam
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thomas Lescot
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francis Bonnet
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Franck Verdonk
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, USA; Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Balciscueta I, Barberà F, Lorenzo J, Martínez S, Sebastián M, Balciscueta Z. Ambulatory laparoscopic cholecystectomy: Systematic review and meta-analysis of predictors of failure. Surgery 2021; 170:373-382. [PMID: 33558068 DOI: 10.1016/j.surg.2020.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Outpatient laparoscopic cholecystectomy has proven to be a safe and cost-effective technique; however, it is not yet a universally widespread procedure. The aim of the study was to determine the predictive factors of outpatient laparoscopic cholecystectomy failure. METHOD A systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis methodology. MEDLINE, Cochrane Library, Ovid, and ISRCTN Registry were searched. The main variables were demographic (age, sex), clinical (weight, American Society of Anesthesiologists classification, previous complicated biliary pathology, history of abdominal surgery in supramesocolic compartment, gallbladder wall thickness), and surgical factors (operative time, afternoon surgery). The secondary variables were the prevalence rates of outpatient laparoscopic cholecystectomy failure due to pain or postoperative nausea and vomiting. RESULTS Fourteen studies (4,194 patients) were included, with a mean outpatient laparoscopic cholecystectomy failure rate of 23.4%. The predictors of outpatient laparoscopic cholecystectomy failure were: age ≥65 years (odds ratio: 2.34; 95% confidence interval, 1.42-3.86; P = .0009), body mass index ≥30 (odds ratio: 1.6; 95% confidence interval, 1.05-2.45; P = .03), American Society of Anesthesiologists score ≥III (odds ratio: 2.89; 95% confidence interval, 1.72-4.87; P < .0001), previous complicated biliary pathology (odds ratio: 2.39; 95% confidence interval, 1.40-4.06; P = .001), gallbladder wall thickening (odds ratio: 2.33; 95% confidence interval, 1.34-4.04; P = .003), surgical time exceeding 60 minutes (mean difference: -16.03; 95% confidence interval,-21.25 to -10.81; P < .00001), and the beginning of surgery after 1:00 pm (odds ratio: 4.20; 95% confidence interval, 1.97-11.96; P = .007). Sex (odds ratio: 1.07; 95% confidence interval, 0.73-1.57, P = .73) and history of abdominal surgery in the supramesocolic compartment (odds ratio: 2.32; 95 confidence interval, 0.92-5.82, P = .07) were not associated with outpatient laparoscopic cholecystectomy failure. CONCLUSION Our meta-analysis allowed us to identify the predictors of outpatient laparoscopic cholecystectomy failure. The knowledge of these factors could help surgeons in their decision-making process for the selection of patients who are suitable for outpatient laparoscopic cholecystectomy.
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Affiliation(s)
- Izaskun Balciscueta
- Department of General and Digestive Surgery, La Ribera University Hospital, Alzira, Valencia, Spain.
| | - Ferran Barberà
- Department of Gynecology and Obstetrics, La Fe University Hospital, Valencia, Spain
| | - Javier Lorenzo
- Department of General and Digestive Surgery, La Ribera University Hospital, Alzira, Valencia, Spain
| | - Susana Martínez
- Department of General and Digestive Surgery, La Ribera University Hospital, Alzira, Valencia, Spain. https://twitter.com/sussana24
| | - Maria Sebastián
- Department of General and Digestive Surgery, La Ribera University Hospital, Alzira, Valencia, Spain
| | - Zutoia Balciscueta
- Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
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Nagem R, Alberti LR, de Campos-Lobato LF. Is It Safe to Recommend Cholecystectomy Whenever Gallstones Develop After Bariatric Surgery? Obes Surg 2020; 31:179-184. [PMID: 32710368 DOI: 10.1007/s11695-020-04862-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cholelithiasis (ChL) is common after bariatric surgery (BS). Laparoscopic cholecystectomy (LC), the preferential treatment, is usually recommended only to symptomatic patients. LC may be, however, beneficial to asymptomatic patients as well. A prerequisite to such a policy is that it must be safe. This study aimed to assess whether, in post-bariatric (Post-Bar) patients who develop gallstones, LC achieves the same results as those reported in the general population. METHODS A cohort of 376 patients undergoing elective LC had their medical records reviewed. Patients were divided into non-bariatric (Non-Bar) and Post-Bar groups, and then compared for characteristics and surgical outcomes. RESULTS The study included 367 patients, 292 Non-Bar and 75 Post-Bar. Considering characteristics, Post-Bar patients were younger (44.5 ± 11.8 vs 48.4 ± 14.1) and less symptomatic (2.4% vs 19.8%) and had a higher BMI (32.2 ± 4.8 vs 30.8 ± 4.4) than Non-Bar patients. Regarding surgical outcomes, mortality (none), morbidity (1%, only in Non-Bar patients), readmission (1%, only in Non-Bar patients), conversion to laparotomy (0.6%, only in Non-Bar patients) showed no difference between the groups. Operative time (42.6 ± 14.4 min in Non-Bar and 38.2 ± 12.6 min in Post-Bar patients) tended to be lower in Post-Bar patients, p = 0.054. Same-day discharge was higher in Post-Bar patients (98.6%) than in Non-Bar patients (90.4%), p = 0.03. CONCLUSIONS Compared with Non-Bar patients, LC in Post-Bar patients showed not only similar morbimortality, readmissions, and conversions but also even a higher same-day discharge rate and a trend to lower operative times.
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Affiliation(s)
- Rachid Nagem
- Department of Surgery, School of Medicine, Federal University of Minas Gerais, 190 Prof. Alfredo Balena Avenue, Belo Horizonte, 30130-100, Brazil.
| | - Luiz Ronaldo Alberti
- Department of Surgery, School of Medicine, Federal University of Minas Gerais, 190 Prof. Alfredo Balena Avenue, Belo Horizonte, 30130-100, Brazil
| | - Luiz Felipe de Campos-Lobato
- Department of Surgery, School of Medicine, Federal University of Minas Gerais, 190 Prof. Alfredo Balena Avenue, Belo Horizonte, 30130-100, Brazil
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The Safety of Laparoscopic Cholecystectomy in the Day Surgery Unit Comparing with That in the Inpatient Unit: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1924134. [PMID: 32420324 PMCID: PMC7206864 DOI: 10.1155/2020/1924134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 11/18/2022]
Abstract
We aimed to perform a systematic review and meta-analysis on the safety of laparoscopic cholecystectomy performed in the day surgery unit versus those performed in the inpatient unit. Several databases including Ovid Embase, Medline Ovid, Cochrane Central, Web of Science, and Google Scholar were searched from inception through February 2019. Our results revealed that laparoscopic cholecystectomy can be conducted safely and effectively in day surgery units, helping bed shortage.
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Postoperative Symptom Distress of Laparoscopic Cholecystectomy Ambulatory Surgery Patients. J Perianesth Nurs 2018; 33:801-813. [PMID: 29426653 DOI: 10.1016/j.jopan.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/27/2017] [Accepted: 12/10/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE The purposes of this study were to (1) identify symptoms that cause postoperative distress in ambulatory surgery patients; (2) identify symptom management techniques that effectively reduce distress of laparoscopic cholecystectomy (LC) postoperative symptoms at home after ambulatory surgery; and (3) identify facilitators and barriers to self-management of postoperative symptoms. DESIGN A qualitative descriptive study. METHODS Two focus groups of ambulatory surgery patients who had experienced a laparoscopic cholecystectomy procedure and their caregivers were queried to elicit understanding of postoperative symptoms and symptom management techniques. FINDINGS Themes identified included distressing symptoms and consequences of surgery, symptom management, and self-management facilitators and barriers. Pain was a major symptom after surgery and impacted mobility and sleep. Participants in our study wanted realistic information about symptoms and more specific information on symptom management. Caregivers were important to the success of symptom management but experienced their own stress. CONCLUSIONS Perianesthesia nurses should focus not only on the immediate recovery, but also prepare patients and their caregivers for the more prolonged issues of recovery at home.
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Zhang Y, Wang Y, Zhang X. Effect of pre-emptive pregabalin on pain management in patients undergoing laparoscopic cholecystectomy: A systematic review and meta-analysis. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.06.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Ismail S, Ahmed A, Hoda MQ, Sohaib M, Zia-Ur-Rehman. Prospective survey to study factors which could influence same-day discharge after elective laparoscopic cholecystectomy in a tertiary care hospital of a developing country. Updates Surg 2016; 68:387-393. [PMID: 27766594 DOI: 10.1007/s13304-016-0403-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 09/19/2016] [Indexed: 12/19/2022]
Abstract
All laparoscopic cholecystectomy (LC) patients in our hospital setting are admitted overnight. This article assesses the contribution of factors like postoperative nausea and vomiting (PONV), postoperative pain and surgical complications to overnight stay after elective LC. This 1-year observational study included patients having normal liver functions undergoing elective LC before 1400 h. The collected data included patient demographics, co-morbidities, PONV, pain scores, complications, surgical time, anesthesia technique, use of prophylactic antiemetics, analgesics, patient satisfaction and desire to have this surgery as day case or in-patient procedure. From 930 LC done per annum, 45.2 % (430/950) patients were included in this study. Prophylactic antiemetic was given in 91.6 %, intraoperative narcotics in 94.2 % patients and multimodal analgesia in 85.3 %. The mean pain score in the recovery and ward was maintained to <4. In the ward, 99.1 % patients were able to start oral fluids after 6 h and were started on oral non-steroidal anti-inflammatory drugs and paracetamol, and none required parental opioid. The PONV score of more than 2 was observed in only 3.2 % of patients in the ward requiring parenteral antiemetic. Surgical complications in the form of bleeding, visceral injury and bile duct leak were observed in 2 % of patients, which was treated intra-operatively. Satisfaction was observed in 99.3 % and desire to stay overnight in 87.4 % of patients. Factors like postoperative pain, PONV and surgical complications were well managed and were not associated with significant morbidity to justify routine overnight admission. However, majority of the patients desired to stay overnight, which could be improved by counseling and education.
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Affiliation(s)
- Samina Ismail
- Department of Anaesthesia, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - Aliya Ahmed
- Department of Anaesthesia, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Muhammad Qamarul Hoda
- Department of Anaesthesia, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Muhammad Sohaib
- Department of Anaesthesia, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Zia-Ur-Rehman
- Department of Surgery, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
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