Outpatient laparoscopic cholecystectomy - Outcomes of 847 planned procedures

Background: Cholecystectomy is now being performed on an outpatient basis a t many centers. The purpose of this study was to review the results of our large experience with this procedure. Methods: Between 1990 and 1997, 2288 patients underwent laparoscopic cholec ystectomy at our clinic. A total of 847 (37%) were scheduled as outpatients . The selection criteria for planned outpatient laparoscopic cholecystectom y called for nonfrail patients with an ASA <4 who were living <2 h from the hospital. All patients received detailed preoperative instruction about ou tpatient laparoscopic cholecystectomy. A questionnaire was sent to 309 pati ents to sample their opinions. Results: Since 1993, we have increased the number of planned outpatient cho lecystectomies performed at our clinic, but the percentage of cholecystecto mies completed on an outpatient basis has remained similar to 60%. A total of 547 of 847 operations scheduled as outpatient procedures (74.5%) were co mpleted as planned, and 204 patients (24%) were kept in the hospital overni ght. Twenty-seven (3%) were converted to open procedures. Eighteen laparosc opic patients (2%) stayed >1 day (range, 2-20). None of the patients died, Of the 142 patients (46%) who completed our opinion survey, 66% were happy with their experience, 32% would like to have stayed in the hospital, and 2 % were undecided. Conclusion: Successful same-day surgery requires proper patient instruction , appropriate patient selection, and a low threshold to convert patients to inpatient status when the situation warrants. No major complications occur red as a result of same-day discharge, and two-thirds of the patients said that they preferred outpatient surgery.