Page 18 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Hindrance to Day Care Laparoscopic Cholecystectomy

in India

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Bhaviya Bhargavan Nair Sarala , Abhimanyu Kar , Supriyo Ghatak , Sumit Gulati , Vishnu K Bhartia , Pradeep K Nemani 6
AbstrAct
Background: Laparoscopic cholecystectomy is considered “gold standard” for the treatment of gallstone disease. In spite of the increasing
number of laparoscopic cholecystectomies being performed as day care surgery in the West, the surgeons of developing countries are reluctant
to adopt this trend probably due to the inadequate resources and infrastructure which they consider a hindrance for safe discharge. Our study
aims to assess the feasibility of day care laparoscopic cholecystectomies.
Materials and methods: This is a prospective observational study. All patients undergoing laparoscopic cholecystectomy were assessed
postoperatively for dischargeability using post-anesthetic discharge scoring system (PADSS). We assessed the factors delaying the early discharge
of laparoscopic cholecystectomy patients in terms of patient factors, intraoperative factors, postoperative factors, social factors, and logistic factors.
Results: Of the total 88 patients, 57 (64.7%) were dischargeable at 6 hours and 78 (88.6%) were dischargeable at 24 hours. Factors found to affect
dischargeability of patients at 6 hours were acute cholecystitis and increased duration of surgery. Difficulty of surgery and the use of drain had
significant association with nondischargeability at 24 hours. Eighteen patients were fit for discharge by PADSS criteria but not discharged at
24 hours. Factors, which delayed the discharge of these patients, were continuation of intravenous antibiotics, delay in processing insurance,
patients’ unwillingness for early discharge, presence of drain, and surgeon’s perceived fear of complications.
Conclusion: Sixty-five percent of all laparoscopic cholecystectomies can be performed as day care procedure safely. Patients with acute
cholecystitis and patients requiring an operative time more than 104 minutes should be observed for 24 hours.
Keywords: Cholecystectomy, Day care surgery, Feasibility, Gallstone, Laparoscopic surgery, Safety.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1396

IntroductIon 1,5,6 Department of General Surgery, Calcutta Medical Research
Laparoscopic cholecystectomy is considered the “gold standard” Institute, Kolkata, West Bengal, India
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for the surgical treatment of gallstone disease. Earlier with open 2–4 Department of Surgical Gastroenterology, Calcutta Medical
cholecystectomies, patients used to stay in the hospital for up Research Institute, Kolkata, West Bengal, India
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to 6 days. The introduction of laparoscopic cholecystectomy Corresponding Author: Bhaviya Bhargavan Nair Sarala, Department
drastically shortened the hospital stay of cholecystectomy of General Surgery, Calcutta Medical Research Institute, Kolkata, West
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patients from 2–3 days. In the Western world, laparoscopic Bengal, India, Phone: +4407404426473, e-mail: bavya_bs@yahoo.co.in
cholecystectomies are being performed as a day care surgery How to cite this article: Sarala BBN, Kar A, Ghatak S, et al. Hindrance
further reducing the stay of patients in hospital to less than a day. to Day Care Laparoscopic Cholecystectomy in India. World J Lap Surg
Outpatient surgery, also known as ambulatory surgery, same- 2020;13(1):16–20.
day surgery, day case, or day surgery, is surgery that does not require Source of support: Nil

an overnight hospital stay. The potential for day care surgery has Conflict of interest: None
increased over the last few decades which can be attributed to the
advances in surgical technologies and in the field of anesthesiology.
Day care surgery allows a person to return home on the same day first we require wide acceptance of overnight or 24 hour discharging
of the operation is performed and eliminates inpatient hospital units followed by gradual upgradation to day care centers. Further
admission, thereby reduces cost. studies on the safety and efficacy of early discharge in laparoscopic
Day care laparoscopic cholecystectomy (DCLC) has already cholecystectomies from smaller centers in India might give the
been widely accepted in Western countries and there are many surgeons the ever lacking confidence in DCLC.
studies on the safety and feasibility of DCLCs. However, these In our institution, the traditional practice is to discharge the
studies are from developed countries where there is advanced patients almost 48 hours after laparoscopic cholecystectomy. We
system for ambulatory surgeries. Because of differences in the wanted to find out whether it was safe and feasible to discharge
quality of health care delivery, Western guidelines for day care these patients as day care (6 hours) or early (24 hours) in a center
surgery cannot be universally applied to developing countries. like ours where there is no dedicated unit for ambulatory surgery.
In most part of eastern India, we still follow the traditional In this prospective observational study, we aim to identify the
practice of discharging the laparoscopic cholecystectomy patients patients suitable for DCLC, factors affecting the dischargeability
the next day or one day after the surgery probably due to lack of at 6 and 24 hours, as well as to find out the factors delaying the
the literature regarding the safety of DCLCs from smaller centers discharge of LC patients more than 24 hours. As day care was not
in developing countries where the primary healthcare delivery and a traditional practice and we were apprehensive on the safety of
infrastructure is poor. For the effective implementation of DCLCs, discharging the LC patients as a day care, we did not discharge
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