Establishing outpatient cholecystectomy as a hospital routine

TL;DR: Outpatient cholecystectomy is a safe hospital routine for all elective procedures without selection and identifying and correcting modifiable factors led to a significant increase in the institutional outpatient rate, comparable to reported individual rates.

Abstract: OBJECTIVE To determine the rate of outpatient cholecystectomies done voluntarily by surgeons and to identify any "correctable" factors leading to hospital admission, also to reassess the outpatient cholecystectomy rate after correcting the identified factors. DESIGN A prospective analysis. SETTING A 256-bed non-teaching acute-care community hospital on the outskirts of a major urban centre, served by 4 general surgeons. PATIENTS All 515 patients booked for elective cholecystectomy at the hospital between Apr. 1, 1994, and Mar. 31, 1996, inclusive. INTERVENTION Elective outpatient cholecystectomy. MAIN OUTCOME MEASURE A successful procedure without compromise of safety. RESULTS In the preliminary study, outpatient cholecystectomy was done in 75% of the patients. Variations in individual surgical practice, preoperative patient selection and inappropriate day surgery facilities were thought to be correctable factors leading to admission. After correction of the these factors (follow-up study), the rate of outpatient cholecystectomy rose to 95% (p < 0.001). Variations in individual surgical practice disappeared, and no patient required processing through inappropriate day surgery facilities. No patient suffered untoward effects from outpatient management. CONCLUSIONS Outpatient cholecystectomy is a safe hospital routine for all elective procedures without selection. Voluntary acceptance of this routine leads to an initial 75% outpatient rate. Identifying and correcting modifiable factors led to a significant increase in the institutional outpatient rate, comparable to reported individual rates.