학술논문
A Prospective Cohort Analysis of the Prevalence and Predictive Factors of Delayed Discharge After Laparoscopic Cholecystectomy in Italy: The DeDiLaCo Study.
Document Type
Academic Journal
Author
Cillara N; Department of Surgery PO SS. Trinità, Cagliari, Italy.; Podda M; Department of Surgical Science, University of Cagliari, Italy.; Cicalò E; Department of Architecture, Design and Urban Planning, University of Sassari, Italy.; Sotgiu G; Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy.; Provenzano M; Department of Surgery PO SS. Trinità, Cagliari, Italy.; Fransvea P; Emergency Surgery and Trauma, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy.; Poillucci G; Policlinico Universitario Umberto I, Rome, Italy.; Sechi R; Department of Surgery PO SS. Trinità, Cagliari, Italy.
Source
Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 100888751 Publication Model: Electronic Cited Medium: Internet ISSN: 1534-4908 (Electronic) Linking ISSN: 15304515 NLM ISO Abbreviation: Surg Laparosc Endosc Percutan Tech Subsets: MEDLINE
Subject
Language
English
Abstract
Background: The concept of early discharge ≤24 hours after Laparoscopic Cholecystectomy (LC) is still doubted in Italy. This prospective multicentre study aims to analyze the prevalence of patients undergoing elective LC who experienced a delayed discharge >24 hours in an extensive Italian national database and identify potential limiting factors of early discharge after LC.
Methods: This is a prospective observational multicentre study performed from January 1, 2021 to December 31, 2021 by 90 Italian surgical units.
Results: A total of 4664 patients were included in the study. Clinical reasons were found only for 850 patients (37.7%) discharged >24 hours after LC. After excluding patients with nonclinical reasons for delayed discharge >24 hours, 2 groups based on the length of hospitalization were created: the Early group (≤24 h; 2414 patients, 73.9%) and the Delayed group (>24 h; 850 patients, 26.1%). At the multivariate analysis, ASA III class ( P <0.0001), Charlson's Comorbidity Index (P=0.001), history of choledocholithiasis (P=0.03), presence of peritoneal adhesions (P<0.0001), operative time >60 min (P<0.0001), drain placement (P<0.0001), pain ( P =0.001), postoperative vomiting (P=0.001) and complications (P<0.0001) were independent predictors of delayed discharge >24 hours.
Conclusions: The majority of delayed discharges >24 hours after LC in our study were unrelated to the surgery itself. ASA class >II, advanced comorbidity, the presence of peritoneal adhesions, prolonged operative time, and placement of abdominal drainage were intraoperative variables independently associated with failure of early discharge.
Competing Interests: The authors declare no conflicts of interest.
(Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
Methods: This is a prospective observational multicentre study performed from January 1, 2021 to December 31, 2021 by 90 Italian surgical units.
Results: A total of 4664 patients were included in the study. Clinical reasons were found only for 850 patients (37.7%) discharged >24 hours after LC. After excluding patients with nonclinical reasons for delayed discharge >24 hours, 2 groups based on the length of hospitalization were created: the Early group (≤24 h; 2414 patients, 73.9%) and the Delayed group (>24 h; 850 patients, 26.1%). At the multivariate analysis, ASA III class ( P <0.0001), Charlson's Comorbidity Index (P=0.001), history of choledocholithiasis (P=0.03), presence of peritoneal adhesions (P<0.0001), operative time >60 min (P<0.0001), drain placement (P<0.0001), pain ( P =0.001), postoperative vomiting (P=0.001) and complications (P<0.0001) were independent predictors of delayed discharge >24 hours.
Conclusions: The majority of delayed discharges >24 hours after LC in our study were unrelated to the surgery itself. ASA class >II, advanced comorbidity, the presence of peritoneal adhesions, prolonged operative time, and placement of abdominal drainage were intraoperative variables independently associated with failure of early discharge.
Competing Interests: The authors declare no conflicts of interest.
(Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)