IS OUTPATIENT LAPAROSCOPIC CHOLECYSTECTOMY WISE

The authors report a prospective analysis of their experience with 506 consecutive laparoscopic cholecystectomies to examine the appropriate ness of outpatient or same-day laparoscopic cholecystectomy. Thirty-ei ght patients experienced at least one postoperative complication, The complication was clinically evident or suspected in only 4 of these 38 patients within 8 h following surgery. Thirty-nine percent and 76% of complications were clinically detected at 24 and 48 h, respectively. Nausea and vomiting occurred among 32% of all patients on the day of o peration and extended into the 1st postoperative day in 10%. Compared to predicted values, forced vital capacity was 61 +/- 5% 1 h postopera tively in 32 patients studied. At 6 and 24 h postoperatively, forced v ital capacity was 63 +/- 7% and 66 +/- 7% respectively. Postoperative analgesic medication requirement was determined in 220 patients who we re provided with a patient-controlled intravenous morphine analgesia m achine with no basal rate, Consumption of morphine was highly variable but substantial on the day of operation: 17 +/- 16 mg. Most complicat ions of laparoscopic cholecystectomy, including life-threatening compl ications, are not apparent by 8 h postoperatively and may not be appar ent at 24 h. The potential for delay in the diagnosis and treatment of complications, variable but substantial analgesic requirements, impai red postoperative ventilation, and postoperative gastrointestinal dysf unction argue for the need to use great caution in selecting patients for outpatient laparoscopic cholecystectomy. Criteria are proposed to identify patients who are safest for outpatient laparoscopic cholecyst ectomy.