Introduction It is recommended by professional bodies that the day surgery target for cholecystectomies should be 60% of cases. Selection for day surgery units and ambulatory care hospitals is important as these may be off site from the acute hospital, and this remains an operation with potentially life threatening complications. We wished to assess clinical factors predicting complex cholecystectomy and test a scoring system on a second cohort of patients.
Method Patients undergoing cholecystectomy at Glasgow’s two ambulatory care hospitals were identified from the theatre data collection programme. In the first cohort we compared patients failing day surgery with similar numbers of consecutive uncomplicated patients. In the second cohort we tested a scoring system based on these results to assess sensitivity and specificity.
Results Comparing 34 patients failing day surgery laparoscopic cholecystectomy (LC), with 39 uncomplicated LC, a number of factors were evident in different proportions between the groups, of which previous cholecystitis, previous jaundice and thickened gallbladder were significant. Patients in the second cohort were given a score of 0–5 based on number of factors present (previous jaundice, ERCP, pancreatitis, cholecystitis and thickened gallbladder). One hundred consecutive patients were assessed. Patients were stratified as having 0–1 factors present or >2 factors present. Sensitivity and specificity for >2 factors present in identifying complicated cholecystectomies was 75% and 80%.
Conclusion Cholecystectomy remains an operation associated with complications of bile leak and conversion to open. This simple preoperative scoring system may help direct patients to specialist surgeons or acute hospitals.
Disclosure of interest None Declared.
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