Laparoscopic cholecystectomy - Outpatient vs inpatient management

Background: This study was undertaken to determine if patients undergoing laparoscopic cholecystectomy may be discharged hone 4 h postoperatively with similar outcomes as patients admitted overnight. Methods: Patients were randomized to an outpatient group (OP). consisting of patients who were discharged after a 4-h stay in the Post Anesthesia Care Unit (PACU), or to an inpatient group. Variables compared between the two groups included patient demographics; degree of postoperative pain, nausea, vomiting, and patient satisfaction; amount of pain and nausea medication taken, and number of phone calls, readmissions. or complications. Statistical analysis was performed with students t-test, Fisher's exact test, and Wilcoxon's signed rank and rank sums tests as appropriate. Results: Eighty patients were initially enrolled. Two were converted and 4 required admission after being randomized to the OP group. Patients in the OP group received more oral pain medication prior to PACU discharge. Degree of pain. number of phone calls. readmission and complication rates, and patient satisfaction were similar between both groups. Of the 4 unexpected admissions. all were identified within the 4-h PACU stay. Conclusions: Patients undergoing laparoscopic cholecystectomy who are discharged home 4 h postoperatively will experience the same satisfaction with no increase in complications as patients admitted overnight.