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Intervention Review

Day-case versus overnight stay for laparoscopic cholecystectomy

  1. Kurinchi Selvan Gurusamy1,*,
  2. Sameer Junnarkar2,
  3. Marwan Farouk3,
  4. Brian R Davidson1

Editorial Group: Cochrane Hepato-Biliary Group

Published Online: 16 JUL 2008

Assessed as up-to-date: 11 APR 2008

DOI: 10.1002/14651858.CD006798.pub3


How to Cite

Gurusamy KS, Junnarkar S, Farouk M, Davidson BR. Day-case versus overnight stay for laparoscopic cholecystectomy. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD006798. DOI: 10.1002/14651858.CD006798.pub3.

Author Information

  1. 1

    Royal Free and University College School of Medicine, University Department of Surgery, London, UK

  2. 2

    Royal Free and University College School of Medicine, Hepato-Biliary Surgery, London, UK

  3. 3

    Buckinghamshire Hospitals NHS Trust, Surgery, Aylesbury, Buckinhamshire, UK

*Kurinchi Selvan Gurusamy, 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.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 16 JUL 2008

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This is not the most recent version of the article. View current version (31 JUL 2013)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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 methods

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 April 2008 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 risk ratio, 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. All the trials were of high risk of bias. 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

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

“門診手術”或“住院手術”對於內視鏡膽囊切除術的比較

雖然門診選擇性內視鏡膽囊切除術可以節省住院費用,其安全性仍尚待確認.

目標

對於接受選擇性內視鏡膽囊切除術之病人,比較“門診手術”與“住院手術”兩者的安全性和利益.

搜尋策略

搜尋Cochrane肝膽群的對照性試驗, Cochrane蒐集已出版的且針對產生對照性實驗的方法使用的書目資訊, Medline, EMBASE,科學引用文獻索引資料庫,直到2007年2月,用搜尋策略來確認隨機性試驗.

選擇標準

我們只考慮納入隨機性臨床試驗來審查,比較門診手術或是住院手術執行選擇性內視鏡膽囊切除術的差別(不論語言,遮盲,刊物狀態).

資料收集與分析

我們依照每個臨床試驗的特性,研究方法的品質,罹病率,延長的住院,再住院,疼痛以及生活品質來蒐集資料.我們採用固定效果模式,以及隨機效果模式,利用Rev Man軟體分析數據.對於每個結果,則估計其相對危險比,

主要結論

五個臨床試驗,429個病人隨機分配至“門診手術(215)”或“住院手術(214)”.這五個臨床試驗的其中四個的偏差(bias)屬於低風險,考慮其隨機分配以及追蹤的方式,但是都無法做到遮盲(blinding).這些臨床試驗涵蓋49%的病人接受膽囊切除術.選擇的條件各異,但是大部分要求病人無其他疾病.病人居住地離醫院都容易到達,並有具責任感的成年人照顧.手術當天有81%的病人都可以出院.隨機分配後退出試驗的比例從6.5%到12.7%不等.至於門診手術或是住院手術,對於發病率,延長住院天數,再住院率,疼痛,生活品質,病人滿意度以及恢復日常活動以及工作方面,皆無顯著差異.

作者結論

對於有症狀的膽結石患者,施行“門診手術”內視鏡膽囊切除術,在選擇性的病人(無疾病或極微全身疾病者,到院無不適),是安全而有效的.因住院天數減低,住院費用也減低.

翻譯人

本摘要由臺中榮民總醫院張崇信翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

施行“門診手術”內視鏡膽囊切除術,在選擇性的病人是安全的,而且超過四分之三的病人都能手術成功.先前我們雖知道“門診手術”內視鏡膽囊切除術可以節省住院費用,其安全性卻待評估.經由這篇對於隨機臨床試驗的系統性審核,我們納入了五個試驗,共429個病人,其中215個接受門診手術,另外214個接受住院手術;這五個試驗中的其中四個,產生誤差的機率低.這些臨床試驗納入49%的病人接受膽囊切除術.每個試驗的納入條件各有不同,但是大多數只選擇沒有其他疾病的病人.病人居住地離醫院都容易到達,並有具責任感的成年人照顧.手術當天有81%的病人都可以出院.隨機分配後退出試驗的比例從6.5%到12.7%不等.至於門診手術或是住院手術,對於發病率,延長住院天數,再住院率,疼痛,生活品質,病人滿意度以及恢復日常活動以及工作方面,皆無顯著差異.對於有症狀的膽結石患者,施行“門診手術”內視鏡膽囊切除術,在選擇性的病人(無疾病或極微全身疾病者,到院無不適),是安全而有效的.因住院天數減低,住院費用也減低.