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Minimally Invasive Surgery
Volume 2011 (2011), Article ID 564587, 5 pages
http://dx.doi.org/10.1155/2011/564587
Research Article

An Effective Approach to Improving Day-Case Rates following Laparoscopic Cholecystectomy

1Oesophagogastric Unit, Department of Upper Gastrointestinal Surgery, Derriford Hospital, Plymouth PL6 8DH, UK
2Department of Anaesthesia, Derriford Hospital, Plymouth PL6 8DH, UK

Received 27 August 2010; Accepted 14 February 2011

Academic Editor: Casey M. Calkins

Copyright © 2011 M. G. Clarke et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Day-case laparoscopic cholecystectomy (LC) is a safe and cost-effective treatment for gallstones. In 2006, our institution recorded an 86% laparoscopic, 10% day-case, and 5% readmission rate. A gallbladder pathway was therefore introduced in 2007 with the aim of increasing daycase rates. Methods. Patients with symptomatic gallstones, proven on ultrasound, were referred to a specialist-led clinic. Those suitable for surgery were consented, preassessed, and provided with a choice of dates. All defaulted to day case unless deemed unsuitable due to comorbidity or social factors. Results. The number of cholecystectomies increased from 464 in 2006 to 578 in 2008. Day-case rates in 2006, 2007, 2008, and June 2009 were 10%, 20%, 30%, and 61%, respectively. Laparoscopic and readmission rates remained unchanged. Conversion rates for elective cholecystectomy fell from 6% in 2006 to 3% in 2009. Conclusions. Development of a gallbladder pathway increased day-case rates sixfold without an associated increase in conversion or readmission rates.