SELECTION CRITERIA FOR LAPAROSCOPIC CHOLECYSTECTOMY IN AN AMBULATORY CARE SETTING

Background: The ambulatory care center offers patient convenience and reduced costs after uneventful laparoscopic cholecystectomy. Methods: A prospectively accumulated database of 1,750 cholecystectomies perfor med by one surgeon in a hospital setting was analyzed to test criteria for ambulatory cholecystectomy. Proposed criteria included age less t han 65, absence of upper abdominal operations, and elective operations in healthy patients at low risk for common bile duct stones. Results: Of 1,750 cholecystectomies, only 605 patients met all criteria for ou tpatient care. Discharge (from the in-hospital setting) was accomplish ed within 24 h of operation in 92% (first 3 years) and 98% (last 4 yea rs) of selected cases. Only one patient (0.2%, 1/605) was converted to an open procedure; another was readmitted 30 h postoperatively with h emorrhage from the liver bed. Conclusions: Laparoscopic cholecystectom y can be performed safely in an ambulatory care setting, given careful selection and education of patients and documented experience of the surgical team.