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Randomized clinical trial of
day-care versus overnight-stay laparoscopic
cholecystectomy
|
BACKGROUND:
Laparoscopic cholecystectomy has been performed as a day-care procedure for
many years. Few studies have been conducted with primary focus on patient
acceptance and preferences in terms of quality of life for this practice
compared with overnight stay.
METHODS:
Data from 100 patients with symptomatic gallstones randomized to
laparoscopic cholecystectomy performed either as a day-care procedure or
with overnight stay were analysed. Complications, admissions and
readmissions, quality of life and health economic aspects were assessed. Two
instruments were used to assess quality of life, the Hospital Anxiety and
Depression Scale (HADS) and the Psychological General Well-Being Index (PGWB).
RESULTS:
Forty-eight (92 per cent) of 52 patients in day-care group were discharged
4-8 h after the operation. Forty-two (88 per cent) of 48 in the overnight
group went home on the first day after surgery. The overall conversion rate
was 2 per cent. Two patients had complications after surgery, both in the
day-care group. No patient in either group was readmitted. There was no
significant difference in total quality of life score between the two
groups. The mean direct medical cost per patient in the day-care group (3085
Euros) was lower than that in the overnight group (3394 Euros).
CONCLUSION:
Laparoscopic cholecystectomy can be performed as a day-case procedure with a
low rate of complications and admissions/readmissions. Patient acceptance in
terms of quality of life variables is similar to that for cholecystectomy
with an overnight stay. The day-care strategy is associated with a reduction
in cost.
Reference:
Br J Surg. 2006 Jan;93(1):40-5. |
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