Early laparoscopic cholecystectomy in oldest-old patients: a propensity score matched analysis of a nationwide registry.

The role of early laparoscopic cholecystectomy (ELC) in "oldest-old" patients with acute calculous cholecystitis (ACC) is still controversial. The aim of this study is to assess the safety of ELC for ACC in ≥ 85-year-old patients. Multicentric retrospective study that analysed data of patients who underwent ELC for ACC between 2013 and 2018. Patients ≥ 85-year-old (oldest-old patients) were compared with younger patients, before and after propensity score matching (PSM). The main outcomes were mortality, post-operative complications, length of stay (LOS), and readmissions. The study included 1670 patients. The unmatched comparison revealed a selection bias towards the oldest-old group, which was associated with higher Charlson Comorbidity Index (5 vs 1, p < 0.001), more ASA III/IV subjects (54.2% vs 19.3%, p < 0.001), class II/III ACC (80.1% vs 69.1%, p = 0.016) and higher Chole-Risk Score (p > 0.001). The oldest-old also required more conversion to open surgery (20% vs 10.3%, p = 0.005). Postoperatively, they had a higher 90-day mortality rate (7.6% vs 1%, p < 0.001), more total complications (40.6% vs 17.7%, p < 0.001), complications ≥ IIIa Clavien-Dindo (14.4% vs 5.8%, p = 0.002), longer LOS (6 vs 5 days, p < 0.001), and more readmissions (6.6% vs 2.6%, p < 0.001). After PSM (n = 206), the two groups were comparable in terms of baseline characteristics and intraoperative outcomes. No differences were observed in post-operative complications; bile leak; incisional, intrabdominal, urinary or respiratory tract infections; LOS or readmissions. In the oldest-old, ELC for ACC is still associated with significant morbidity and mortality. However, it seems to be safe in selected patients. Therefore, age itself should not be regarded as a contraindication to ELC for ACC.

Laparoscopic cholecystectomy for acute cholecystitis: is the surgery still safe beyond the 7-day barrier? A multicentric observational study.

Timing for early laparoscopic cholecystectomy (ELC) in patients with acute calculous cholecystitis (ACC) is still controversial. This study assesses ELC for ACC with delayed presentation, according to hospital volume. Multicentric retrospective analysis of 1868 ELC. Patients were classified into two groups according to the timing of surgery from clinical onset and centre volume. Group 1 (G1) within the first 7 days, group 2 (G2) beyond that. Then centres were classified in low volume centres (LVC) and higher volume centres (HVC) according to the number of ELC performed per year. Overall, G2 showed increased conversion rate (17.7% vs 10.7%; p = 0.004), intraoperative complications (7.3% vs 2.9%; p = 0.001); postoperative haemorrhage (3.6% vs 0.8%; p < 0.001), infections (16.6% vs 9.3%; p = 0.003) and global complications (27.6% vs 19.8%; p = 0.011). HVC in comparison with LVC presented decreased conversion rate (17.1% vs 7.6%; p < 0.001), intraoperative bleeding (2.1% vs 1%; p = 0.047), postoperative bile leakage (4.1% vs 2.1%; p = 0.011), infectious (13.7% vs 7.5%; p < 0.001) and global complications (25.7% vs 17.1%; p < 0.001). HVC did not show an increase in any of the above-mentioned outcomes when G1 and G2 were compared. ELC must be indicated cautiously in patients with ACC and more than 1 week of symptom duration. It should be performed in centres with sufficient experience in the management of this disease.

Colecistectomía laparoscópica ambulatoria versus con ingreso: estudio de efectividad y calidad / Comparative study of ambulatory laparoscopic cholecystectomy versus management of laparoscopic cholecystectomy with conventional hospital stay

Introducción Analizar la efectividad y calidad de la colecistectomía laparoscópica en régimen ambulatorio (CLCMA) frente al manejo convencional de la colecistectomía laparoscópica con estancia (CLEST).Material y métodos Estudio retrospectivo donde se analizan todos los pacientes ASA I-II, durante 6 años, intervenidos mediante colecistectomía laparoscópica (CL). Se establecen 2 cohortes de pacientes: grupo CLCMA (n = 141 pacientes) y grupo CLEST (n = 286 pacientes).La efectividad se analizó evaluando morbimortalidad, reintervenciones, reingresos y estancia. El análisis de calidad del grupo CLCMA se realizó mediante encuestas de satisfacción y posterior valoración mediante indicadores de satisfacción. Resultados No existieron diferencias estadísticamente significativas entre ambos grupos (CLEST vs CLCMA) en morbilidad (5,24 vs 4,26), reintervenciones (2,45 vs 1,42) ni en reingresos (1,40 vs 3,55). No hubo mortalidad postoperatoria. El 82% de los pacientes del grupo CLCMA fueron alta el mismo día de la intervención, siendo la estancia media de este grupo 1,16 días, mientras que en el grupo CLEST fue de 2,94 días (p = 0,003). El índice de satisfacción global fue de un 82% y el indicador de satisfacción de la asistencia recibida fue del 81%, ambos por encima del estándar previamente fijado. Conclusiones La CLCMA es tan efectiva y segura como la CLEST programada, con un buen nivel de calidad percibida (AU)

Introduction To analyse the effectiveness and quality of ambulatory laparoscopic cholecystectomy (CLCMA) versus management of laparoscopic cholecystectomy with conventional hospital stay (CLEST).Material and methods A retrospective study was conducted on all patients ASA I-II, who had a laparoscopic cholecystectomy (LC) over a period of 6 years. The patients were divided into 2 groups: group CLCMA (n = 141 patients) and group CLEST (n = 286 patients).The effectiveness was analysed by evaluating morbidity, further surgery, re-admission and hospital stay. The quality analysis was performed using CLCMA group satisfaction surveys and subsequent assessment by indicators of satisfaction. Results There was no significant differences between groups (CLEST vs. CLCMA) in morbidity (5.24 vs 4.26), further surgery (2.45 vs. 1.42) or re-admissions (1.40 vs. 3.55). There was no postoperative mortality. In the CLCMA group 82% of patients were discharged on the same day of surgery, with a mean stay of 1.16 days, while in the CLEST group the mean hospital stay was 2.94 days (P=.003).The overall satisfaction rate was 82%, and the level of satisfaction of care received was 81%, both above the previously set standard. Conclusions CLCMA is just as effective and safe as hospital based CLEST, with a good level of perceived quality (AU)

[Comparative study of ambulatory laparoscopic cholecystectomy versus management of laparoscopic cholecystectomy with conventional hospital stay]. / Colecistectomía laparoscópica ambulatoria versus con ingreso: estudio de efectividad y calidad.

INTRODUCTION: To analyse the effectiveness and quality of ambulatory laparoscopic cholecystectomy (CLCMA) versus management of laparoscopic cholecystectomy with conventional hospital stay (CLEST). MATERIAL AND METHODS: A retrospective study was conducted on all patients ASA I-II, who had a laparoscopic cholecystectomy (LC) over a period of 6 years. The patients were divided into 2 groups: group CLCMA (n = 141 patients) and group CLEST (n = 286 patients). The effectiveness was analysed by evaluating morbidity, further surgery, re-admission and hospital stay. The quality analysis was performed using CLCMA group satisfaction surveys and subsequent assessment by indicators of satisfaction. RESULTS: There was no significant differences between groups (CLEST vs. CLCMA) in morbidity (5.24 vs 4.26), further surgery (2.45 vs. 1.42) or re-admissions (1.40 vs. 3.55). There was no postoperative mortality. In the CLCMA group 82% of patients were discharged on the same day of surgery, with a mean stay of 1.16 days, while in the CLEST group the mean hospital stay was 2.94 days (P=.003).The overall satisfaction rate was 82%, and the level of satisfaction of care received was 81%, both above the previously set standard. CONCLUSIONS: CLCMA is just as effective and safe as hospital based CLEST, with a good level of perceived quality.

Colecistectomía laparoscópica en régimen de cirugía mayor ambulatoria en un hospital comarcal: resultados iniciales de una serie de 110 casos / Laparoscopic cholecystectomy performed as ambulatory major surgery in a regional hospital. Initial results of a series of 110 cases

Introducción El objetivo del estudio es analizar la fiabilidad de la colecistectomía laparoscópica (CL) realizada en el ámbito de cirugía mayor ambulatoria (CMA) para generalizar su uso y conseguir una mejor gestión de los recursos sanitarios. Material y método Estudio retrospectivo en el que se analizan 110 pacientes intervenidos de CL entre septiembre de 2004 y noviembre de 2008. Los criterios de selección fueron ausencia de cirugía abdominal supramesocólica previa, ausencia de ingresos previos por colecistitis aguda, ausencia de litiasis en la vía biliar principal y pruebas de función hepática normales, ausencia de ingesta de anticoagulantes orales o antiagregantes plaquetarios y clasificación I y II de la American Society of Anesthesiologists. Todos los pacientes fuern intervenidos bajo el protocolo de CMA previamente establecido. Resultados Se intervino a 81 mujeres y 29 varones, con una media de edad de 51,03 años (rango: 24–77). Cincuenta y siete pacientes presentaban antecedentes médicos o quirúrgicos. Resultados La morbilidad general fue del 6,36% con una mortalidad del 0%. La tasa de conversión fue del 0,9%. Ochenta y siete pacientes (79,1%) fueron dados de alta a las 6h de la intervención, cumpliendo así el régimen de CMA. La estancia hospitalaria global media fue de 1,49 días (mediana 0). La tasa de reintervenciones fue del 1,81% y la tasa de reingresos tras el alta fue del 0,9%.ConclusionesLa realización de CL en CMA es factible y segura. Debería estar integrada en la actividad de las unidades de CMA, siempre que exista una correcta selección de los pacientes y un especial interés por parte de los cirujanos que la realicen (AU)

Introduction The aim of our study was to analyze the reliability of laparoscopic cholecystectomy (LC) in an Ambulatory Surgery unit, in order to encourage its use and achieve better management of health resources. Material and method Retrospective study of 110 patients operated on for LC between September 2004 and November 2008. The selection criteria were: absence of prior supramesocolic abdominal surgery, no previous admission for acute cholecystitis, absence of stones in the bile ducts and normal liver function tests, no intake of oral anticoagulants or antiplatelet agents and ASA I-II. All patients were operated using a previously established Major Ambulatory Surgery (MAS) protocol. Results The patients included 81 women and 29 men, with a mean age of 51.03 years (range 24–77), of which 57 had a medical and / or surgical history. Results The overall morbidity was 6.36% with a mortality of 0%. The conversion rate was 0.9%. A total of 87 patients (79.1%) were discharged at 6h after surgery, thus fulfilling the criteria of the MAS system. The mean overall hospital stay was 1.49 days (median 0). The reoperation rate WAS 1.81% and the rate of readmission after discharge was0.9%.ConclusionsThe performance of outpatient laparoscopic cholecystectomy is feasible and safe. It should be integrated into the activities of Major Ambulatory Surgery, ensuring careful selection of patients and interest by surgeon who performs it (AU)

[Laparoscopic cholecystectomy performed as ambulatory major surgery in a regional hospital. Initial results of a series of 110 cases]. / Colecistectomía laparoscópica en régimen de cirugía mayor ambulatoria en un hospital comarcal: resultados iniciales de una serie de 110 casos.

INTRODUCTION: The aim of our study was to analyze the reliability of laparoscopic cholecystectomy (LC) in an Ambulatory Surgery unit, in order to encourage its use and achieve better management of health resources. MATERIAL AND METHOD: Retrospective study of 110 patients operated on for LC between September 2004 and November 2008. The selection criteria were: absence of prior supramesocolic abdominal surgery, no previous admission for acute cholecystitis, absence of stones in the bile ducts and normal liver function tests, no intake of oral anticoagulants or antiplatelet agents and ASA I-II. All patients were operated using a previously established Major Ambulatory Surgery (MAS) protocol. RESULTS: The patients included 81 women and 29 men, with a mean age of 51.03 years (range 24-77), of which 57 had a medical and / or surgical history. The overall morbidity was 6.36% with a mortality of 0%. The conversion rate was 0.9%. A total of 87 patients (79.1%) were discharged at 6h after surgery, thus fulfilling the criteria of the MAS system. The mean overall hospital stay was 1.49 days (median 0). The reoperation rate WAS 1.81% and the rate of readmission after discharge was 0.9%. CONCLUSIONS: The performance of outpatient laparoscopic cholecystectomy is feasible and safe. It should be integrated into the activities of Major Ambulatory Surgery, ensuring careful selection of patients and interest by surgeon who performs it.