Day Care Laparoscopic Cholecystectomy: A Feasibility Study in a Public Health Service Hospital in a Developing Country

• Published in: World journal of surgery Vol. 30; no. 9; pp. 1690 - 1695
• Main Authors: Chauhan, A., Mehrotra, M., Bhatia, P.K., Baj, B., Gupta, A.K.
• Format: Journal Article
• Language: English
• Published: New York Springer‐Verlag 01-09-2006; Springer; Springer Nature B.V
• Subjects: Adult; Ambulatory Surgical Procedures - standards; Ambulatory Surgical Procedures - utilization; Biological and medical sciences; Cholecystectomy, Laparoscopic - methods; Cholecystolithiasis - surgery; Developing Countries; Feasibility Studies; General aspects; Hospitalization - statistics & numerical data; Hospitals, Public - standards; Hospitals, Public - utilization; Humans; India; Laparoscopic Cholecystectomy; Length of Stay; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Middle Aged; Outcome Assessment (Health Care); Physical Status Score; Prospective Studies; Public Health Service; Quality Indicators, Health Care; Readmission Rate; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Unplanned Admission; Utilization Review; India; Cholecystectomy; Medicine; Endoscopic surgery; Treatment; Developing countries; Gallbladder; Feasibility; Hospitalization; Health service; Hospital; Public health; Care
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-006-0023-7

Background
Day care laparoscopic cholecystectomy (DCLC) has been shown to be safe in centers with adequate infrastructure for day care surgery in economically advanced countries. However, the feasibility of applying this concept in public health service hospitals in less developed and developing nation needs to studied. Unique protocols need to be developed and tested, taking into account local conditions and infrastructural constraints.
Patients and methods
Patients less than 60 years old, graded I and II on the American Society of Anesthesiologists (ASA) physical status score, living within one hour traveling time and willing to make their own arrangements for a return to hospital in case of problems, were selected for DCLC.
Results
291 cases (78%) out of 373 laparoscopic cholecystectomies done in one calendar year were found suitable for DCLC. The most common cause for omitting from DCLC was that the patient lived out of the defined area (57%). Four of 291 (1.3%) cases were cancelled due to medical condition; 270/287 (96.1%) were discharged the same evening as surgery; 6 patients were converted to open surgery; and 11 did not meet the necessary discharge criteria. Eight of 270 (2.9%) required readmission out of which 3 (1.1%) required intervention. Overall, incidence of complication rate was 3.4%. Analysis of data showed that results were comparable to previously published studies, hence extrapolating that inclusion and discharge criteria used in the study are valid. However, there are certain social constraints which hinder truly universal application of DCLC.
Conclusions
DCLC is a safe and technically feasible concept, even in public health service centers without dedicated ambulatory surgery units. It has potential for much economical and social benefit in these countries.