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The Influence of Analgesia, Antiemetics and Operative Factors on Admission Following Cholecystectomy: a Retrospective Review
Mark Bignell*, Anna Bayston, David Nunn, Michael P. Lewis
General Surgery, Norfolk and Norwich university Hospital, Norwich, United Kingdom
Introduction
Laparoscopic cholecystectomy is the most commonly performed elective abdominal operation and can be performed as a day case procedure. However day case rates in the UK vary widely between hospitals with figures ranging from 6.4% to 50% with higher performing centres feeling rates up to 70% are achievable. The reasons for such disparity between hospitals is multifactorial and therefore a retrospective review was undertaken to determine if any perioperative factors influenced length of stay.
Methods
100 patients (50 day case and 50 overnight stay) who underwent elective laparoscopic cholecystectomy were subjected to a medical note review. Information on operative time, duration, surgeon, anaesthetist, patient demographics and perioperative medication such as the use of opiates and antiemetics were collected. Statistical analysis was undertaken using a Fishers’ exact test.
Results
The mean age in the day case group was 48 years compared to 55 years in the overnight group (NS). There were 12 males in the day case group compared to 13 in the overnight group. The mean ASA was 2 in both groups (range 1-2 in each group). 80% (n=40) of day case patients had an anaesthetic start time before 12pm compared to 48% (n=24) in the overnight group (p=0.0016). Intraoperative morphine was used in 40% (n=20) of day case patients compared to 68% (n=34) of overnight patients (p=0.0088) whilst this use changed to 6% (n=3) and 26% (n=13) respectively in recovery (p=0.0122). The use of fentanyl was not statistically significant between the two groups intraoperatively or in recovery (88% versus 86% intraoperatively and 52% versus 60% in recovery). Dexamethasone was used in 92% (n=46) of day case patients intraoperatively compared to 70% (n=35) in the overnight group (p=0.0095). The use of ondansetron was not significantly different between the two groups.
Conclusion
Anaesthetic start time and the use of fentanyl and dexamethasone are associated with a shorter stay in hospital whilst the use of morphine either intraoperatively or in recovery leads to a longer length of stay following elective laparoscopic cholecystectomy.
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