Abstracts
1997 Digestive Disease Week

Is outpatient laparoscopic surgery safe for the higher risk patient?

J Andrus, J Voitk, S Ignatius, BD Schouten, RA Mustard. The Salvation Army Scarborough Grace Hospital, Scarborough, Ontario, and The Wellesley-Central Hospital, The University of Toronto, Toronto, Ontario, Canada.

To determine the safety of outpatient laparoscopic surgery under general anesthesia for the higher risk patient, 100 consecutive patients booked as outpatients for elective laparoscopic cholecystectomy or laparoscopic transabdominal preperitoneal inguinal hernia repair were studied. Operations were carried out between 1992 and 1996 by the same surgeon (AJV) and assistant at a 256 bed non-teaching community hospital. Higher risk was defined as age over 70 or American Society of Anesthesiologists physical status classification of 3 or greater. The X² and student's t tests were used to determine probability and p<0.05 considered significant. Among 431 consecutive patients booked for outpatient laparoscopic surgery there were 100 higher risk patients. Age was a risk factor for 66 and comorbidity for 66; 32 had a combination of both risk factors. Hernia repair patients made up 26% of the reference population and 40% of the higher risk group. Sex distribution, operative time, rates of admission, readmission, complications and length of stay for admitted patients were similar for higher risk and lower risk patients but the higher risk patients had a greater rate of conversion (10% vs 2%). Readmission rates were 2% for both the lower risk and higher risk patients; no readmission was related to outpatient treatment. 17 of the 100 higher risk outpatients required admission to hospital (10 because of conversion and 7 for other reasons). The need for hospitalization became readily apparent in the perioperative period in each case. Both readmissions came from this group. Sex, age and operative time were similar for admitted and outpatient higher risk patients, whereas admitted patients had significantly higher rates of conversion and readmission. The 83 higher risk patients who were successfully treated as outpatients had no complications related to their outpatient status, did not decompensate later and did not require subsequent readmission to hospital. Outpatient laparoscopic surgery is safe for the higher risk patient. 83% can be successfully treated as outpatients. For the 17% who require hospital admission, the indications become readily apparent during a brief period of perioperative observation. Higher risk patients who recover uneventfully from surgery and remain stable do not destabilize later; they can be discharged on the day of operation without harmful effects or need for subsequent readmission.