Outpatient versus inpatient laparoscopic cholecystectomy:a single center clinical analysis

BACKGROUND: Outpatient laparoscopic cholecystectomy (OPLC) developed in the United States and other developed countries as one of the fast-track surgeries performed in ambulatory centers. However, this practice has not been installed as a routine practice in the major general hospitals and medical centers in China. We designed this case-control study to evaluate the feasibility, benefits, and safety of OPLC. METHODS: Two hundred patients who had received laparoscopic cholecystectomy for various benign gallbladder pathologies from April 2007 to December 2008 at Jinling Hospital of Nanjing University School of Medicine were classified into two groups: OPLC group (100 patients), and control group (100), who were designated for inpatient laparoscopic cholecystectomy (IPLC). Data were collected for age, gender, indications for surgery, American Society of Anesthesiology (ASA) class, operative time, blood loss during surgery, length of hospitalization, and intra- and post-operative complications. The expenses of surgery and in-hospital care were calculated and analyzed. The operative procedures and instrumentation were standardized for laparoscopic cholecystectomy, and the procedures were performed by two attending surgeons specialized in laparoscopic surgery. OPLC was selected according to the standard criteria developed by surgeons in our hospital after review. Reasons for conversion from laparoscopic to open cholecystectomy were recorded and documented. RESULTS: One hundred patients underwent IPLC following the selection criteria for the procedure, and 99% completed the procedure. The median operative time for IPLC was 24.0 minutes, blood loss was 16.2 ml, and the time for resuming liquid then soft diet was 10.7 hours and 22.0 hours, respectively. Only one patient had postoperative urinary infection. The mean hospital stay for IPLC was 58.2 hours, and the cost for surgery and hospitalization was 8770.5 RMB yuan on average. Followup showed that 90% of the patients were satisfied with the procedure. In the OPLC group, 99% of the patients underwent the procedure with a median operative time of 21.6 minutes and bleeding of 14.7 ml. The patients took liquid 11.3 hours then soft diet 20.1 hours after surgery. The mean postoperative hospital stay was 28.5 hours. In this group, 89% of the patients were discharged within the first 24 hours, and the remaining 11% were released within 48 hours after surgery. Two patients developed local complications. The cost for surgery and hospitalization was 7235.7 RMB yuan, which was 17.5% less than that in the IPLC group. At follow-up, 94% of the patients were satisfied with the surgery and short hospital stay. CONCLUSIONS: OPLC can effectively treat a variety of benign, non-acute gallbladder diseases with shortened waiting time and postoperative hospital stay. OPLC benefits the hospital with a rapid bed turnover rate, and reduces cost for surgery and hospitalization.

Comparing complications of outpatient management of slipped capital femoral epiphysis and Blount’s disease:A database study

BACKGROUND Currents trends in pediatric orthopaedics has seen an increase in surgeries being successfully completed in an outpatient setting.Two recent examples include slipped capital femoral epiphysis(SCFE)and Blount’s disease.Surgical indications are well-studied for each pathology,but to our knowledge,there is an absence in literature analyzing safety and efficacy of inpatient vs outpatient management of either condition.We believed there would be no increase in adverse outcomes associated with outpatient treatment of either conditions.AIM To investigate whether outpatient surgery for SCFE and Blount’s disease is associated with increased risk of adverse outcomes.METHODS The 2015-2017 American College of Surgeons National Surgical Quality Improvement Program Pediatric Registries were used to compare patient characteristics,rates of complications,and readmissions between outpatient and inpatient surgery for SCFE and Blount’s disease.RESULTS Total 1788 SCFE database entries were included,30%were performed in an outpatient setting.In situ pinning was used in 98.5%of outpatient surgeries and 87.8%of inpatient surgeries(P<0.0001).Inpatients had a greater percent of total complications than outpatients 2.57%and 1.65%respectively.Regarding Blount’s disease,outpatient surgeries constituted 41.2%of the 189 procedures included in our study.The majority of inpatients were treated with a tibial osteotomy,while the majority of outpatients had a physeal arrest(P<0.0001).Complications were encountered in 7.4%of patients,with superficial surgical site infections and wound dehiscence being the most common.1.6%of patients had a readmission.No differences in complication and readmission risks were found between inpatients and outpatients.CONCLUSION The current trend is shifting towards earlier discharges and performing procedures in an outpatient setting.This can be safely performed for a large portion of children with SCFE and Blount’s disease without increasing the risk of complications or readmissions.Osteotomies are more commonly performed in an inpatient setting where monitoring is available.

Enhanced recovery after surgery protocols for outpatient operations in otolaryngology:Review of literature

Objective:Enhanced recovery after surgery(ERAS)protocols are patient-centered,evidence-based pathways designed to reduce complications,promote recovery,and improve outcomes following surgery.These protocols have been successfully applied for the management of head and neck cancer,but relatively few studies have investigated the applicability of these pathways for other outpatient procedures in otolaryngology.Our goal was to perform a systematic review of available evidence reporting the utility of ERAS protocols for the management of patients undergoing outpatient otolaryngology operations.Methods:A systematic literature review was conducted using MEDLINE,EMBASE,SCOPUS,and gray literature.We identified studies that evaluated ERAS protocols among patients undergoing otologic,laryngeal,nasal/sinus,pediatric,and general otolaryngology operations.We assessed the outcomes and ERAS components across protocols as well as the study design and limitations.Results:A total of eight studies fulfilled the inclusion criteria and were included in the analysis.Types of procedures evaluated with ERAS protocols included tonsillectomy and adenoidectomy,functional endoscopic sinus surgery,tympanoplasty and mastoidectomy,and septoplasty.A reduction in postoperative length of stay and hospital costs was reported in two and three studies,respectively.Comparative studies between ERAS and control groups showed persistent improvement in pre-and postoperative anxiety and pain levels,without an increase in postoperative complications and readmission rates.Conclusions:A limited number of studies discuss implementation of ERAS protocols for outpatient operations in otolaryngology.These clinical pathways appear promising for these procedures as they may reduce length of stay,decrease costs,and improve pain and anxiety postoperatively.