Laparoscopic cholecystectomy: Day-care versus clinical observation

Objective To determine the feasibility and desirability of laparoscopic cholecystecto my (LC) in day-care versus LC with clinical observation. Summary Background Data Laparoscopic cholecystectomy has been performed regularly as outpatient sur gery in patients with uncomplicated gallstone disease in the United States, but this has not been generally accepted in Europe. The main objections ar e the risk of early severe complications (bleeding) or other reasons for re admission, and the argument that patients might feel safer when observed fo r one night. Quality-of-life differences hitherto have not been investigate d. Methods Eighty patients (American Society of Anesthesiology [ASA] I/II) with sympto matic gallstones were randomized to receive LC either in day-care or with c linical observation. Complications, (re)admissions, consultations of genera l practitioners or the day-care center within 4 days after surgery, use of pain medication, quality of life, convalescence period, time off from profe ssional activities, and treatment preference were assessed. The respective costs of day-care and clinical observation were determined. Results Of the 37 patients assigned to the day-care group who underwent elective su rgery, 92% were discharged successfully after an observation period of 5.7 +/- 0.2 hours. The remainder of the patients in this group were admitted to the hospital and clinically observed for 24 hours. For the 37 patients in the clinical observation group who underwent electiv e surgery, the observation time after surgery was 31 +/- 3 hours. Three patients in the day-care group and one patient in the clinical observ ation group had complications after surgery. None of the patients in either group consulted a general practitioner or the hospital during the first we ek after surgery. Use of pain medication was comparable in both groups over the first 48 hour s after surgery. There were no differences in pain and other quality-of-lif e indicators between the groups during the 6 weeks of follow-up. Of the patients in the day-care group, 92% preferred daycare to clinical ob servation. The same percentage of patients in the clinical observation grou p preferred at least 24 hours of observation to day-care. Costs for the day-care patients were substantially lower (approximately $75 0/patient) than for the clinical observation patients. Conclusion Effectiveness was equal in both patient groups, and both groups appeared to be satisfied with their treatment. Because no differences were found with respect to the other outcomes, day-care is the preferred treatment in most ASA I and II patients because it is less expensive.