2005 Abstracts: Randomized Clinical Trial of Day-Care Versus Overnight Stay Laparoscopic Cholecystectomy
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Randomized Clinical Trial of Day-Care Versus Overnight Stay Laparoscopic Cholecystectomy
Anders Thune, Dept of Surgery, Sahlgrenska University Hospital, Molndal, Gotaland, Sweden; Leif Nelvin, Mikael G. Johansson, Dept of Surgery Sahlgrenska Universitetssjukhuset, Molndal, Gotaland, Sweden; Lars Lundell, Dept of Surgery Karolinska Sjukhuset, Huddinge, Svealand, Sweden
Background: Laparoscopic cholecystectomy has been performed regularly as a day-care procedure for many years. Although the safety and feasibility of the day-care setting has been firmly established, there are very few randomized clinical trials, with primary focus on patient acceptance and preferences in terms of quality of life, compared to the practice of overnightstay.
Patients and methods: One-hundred patients with symptomatic gallstones were randomised to LC performed either as a day-care procedure or with an overnight stay. Complications admissions/readmissions, quality of life, and health economic aspects were assessed. Results: Fifty-two patients were allocated to the day-care group, of whom 48 (92) were discharged 4-8 hours after the operation. In the overnight-stay group 42 patients (88) went home on the first postoperative day whereas the others were discharged the following day Overall conversion rate was 2 (two patients in the day-care group). Two patients had complications after surgery, both in the day-care group. No patients were readmitted in other of the groups. To assess quality of life two instruments were used: Hospital Anxiety and Depression Scale (HADS) and Psychological General Well-being Index (PGWB) HADS was assessed preoperatively, one day and one week after surgery and showed no significant differences between the groups. PGWB was measured one day and one week postoperatively. There was a significant difference in the dimensions of vitality and general health (p<0.01) on the first postoperative day m favour overnight stay, but no significant difference in total score. Direct medical costs was €3085 for day-care and €3394 for overnight stay. Conclusion: LC as a day-case procedure can be performed with a low rate of complications and admissions/readmissions. Patient acceptance in terms of quality of life variables show a significant difference in favour of overnight stay in some dimensions, but no major differences can be demonstrated. The reduction of cost using a day-care strategy was €310/patient.
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