Get access

Day-case versus overnight stay in laparoscopic cholecystectomy

  • Review
  • Intervention

Authors

  • KS Gurusamy,

  • S Junnarkar,

  • M Farouk,

  • BR Davidson


Dr Kurinchi Gurusamy, Research Fellow, University Department of Surgery, Royal Free and University College School of Medicine,, 9th Floor, Royal Free Hospital,, Pond Street, London, NW3 2QG, UK. kurinchi2k@hotmail.com.

Abstract

Background

Although day-case elective laparoscopic cholecystectomy can save bed costs, its safety remains to be established.

Objectives

To assess the safety and benefits of day-case surgery compared to overnight stay in patients undergoing elective laparoscopic cholecystectomy.

Search strategy

We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until February 2007 for identifying randomised trials using search strategies.

Selection criteria

Only randomised clinical trials, irrespective of language, blinding, or publication status, comparing day-case and overnight stay in elective laparoscopic cholecystectomy were considered for the review.

Data collection and analysis

We collected the data on the characteristics of the trial, methodological quality of the trials, morbidity, prolonged hospitalisation, re-admissions, pain and quality of life from each trial. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. For each outcome we calculated the relative risk, weighted mean difference, or standardised mean difference with 95% confidence intervals (CI) based on available case-analysis.

Main results

Five trials with 429 patients randomised to the day-case group (215) and overnight stay group (214) were included in the review. Four of the five trials were of low risk of bias regarding randomisation and follow up, but all lacked blinding. The trials recruited 49% of patients undergoing cholecystectomy. The selection criteria varied, but most included only patients without other diseases. The patients were living in easy reach of the hospital and with a responsible adult to take care of them. On the day of surgery, 81% of day-case patients were discharged. The drop-out rate after randomisation varied from 6.5% to 12.7%. There was no significant difference between day-case and overnight stay group as regards to morbidity, prolongation of hospital stay, re-admission rates, pain, quality of life, patient satisfaction and return to normal activity and work.

Authors' conclusions

Day-case elective laparoscopic cholecystectomy seems to be a safe and effective intervention in selected patients (with no or minimal systemic disease and within easy reach of the hospital) with symptomatic gallstones. Because of the decreased hospital stay, it is likely to save costs.

Plain language summary

Plain language summary

Day-case laparoscopic cholecystectomy seems to be safe and can be done successfully in more than three-quarters of selected patients

Although day-case laparoscopic cholecystectomy (removal of gallbladder through keyhole surgery) can save bed costs, its safety has to be established. In this systematic review of randomised clinical trials, we included five trials with 429 patients randomised to day-case group (215 patients) and to overnight stay group (214 patients). Four of the five trials were of low risk of bias. The trials recruited 49% of patients undergoing cholecystectomy (removal of gallbladder). The selection criteria varied, but most included only patients without other diseases. The patients were living in easy reach of the hospital and with a responsible adult to take care of them. 81% of day-case patients were discharged on the day of surgery. The drop-out rate after randomisation varied between 6.5% and 12.7%. There was no significant difference between day-case and overnight stay group as regards to complications, prolongation of hospital stay, re-admission rates, pain, quality of life, patient satisfaction, and return to normal activity and work. Day-case elective laparoscopic cholecystectomy seems to be safe and effective treatment in selected patients (with no or minimal systemic disease and within easy reach of the hospital) with symptomatic gallstones. Because of the decreased hospital stay, it is likely to save costs.

Ancillary