Analysis of the causes of unanticipated admission after ambulatory laparoscopic cholecystectomy may permit the identification of predictive clinical factors for postoperative admission.
A new study by Dr Hung Lau and Dr David C. Brooks has used univariate and multivariate analyses of clinical variables associated with unplanned admission in a retrospective case-control series of ambulatory laparoscopic cholecystectomies.
The study, which was conducted in a major university-affiliated teaching hospital, involved 731 consecutive patients. All underwent ambulatory laparoscopic cholecystectomies between January 1996 and December 1999.
In addition to the unplanned postoperative admissions, the study group also carried out analyses of 19 clinicopathologic factors to identify independent predictive factors for these admissions.
| Length of operation predicted unplanned admission.
| Annals of Surgery |
Of the 731 patients enrolled into the study, 706 were discharged on the day of operation.
The remaining 25 required admission because of pain (n = 10), nausea and vomiting (n = 6), retention of urine (n = 5), patient preference (n = 3), and medical observation (n =1). This gave an unanticipated admission rate of 3.4%.
Significant factors associated with unplanned admission included operative duration of longer than 60 minutes, and thickened gallbladder wall on ultrasonographic and pathologic findings.
By means of logistic regression, length of operation was found to be the only independent predictive factor.
Operative time exceeding 60 minutes incurred a 4-fold increased risk for unanticipated admission.
The authors conclude that operative duration was the best predictive factor for unplanned admission after ambulatory laparoscopic cholecystectomy.
They add that, during selection of patients for day surgery, ultrasonographic demonstration of a thickened gallbladder wall should also be taken into consideration.