BMC surgery · 2026
A four-year analysis of the predictors of overnight stay in day-case laparoscopic cholecystectomy and the prevention strategies within two centers in the UK: a double-centric retrospective observational study.
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Abuahmed Mohamed, Karmarkar Rahi, Naeem Muhammad, Rashid Rahel, Eskandar George, Varghese Merene, Mishra Mayank, Wilson Jeremy, Magee Conor
Аннотация
BACKGROUND: Laparoscopic cholecystectomy (LC) is the mainstay treatment of benign gallbladder disease, most commonly gallstones. Although the recent guidelines of British Association of Day-Surgery (BADS) and World Society of Emergency Surgery (WSES) recommend same-day discharge (i.e. day-case surgery), there is still a considerable proportion of cases that get admitted unexpectedly overnight. The primary aim of this study is to determine the predictors of overnight stay and consequently develop prevention strategies.
MATERIALS AND METHODS: This was a retrospective study involving 913 patients who underwent intended day-case LC between 2020 and end of 2023, in two centers in the UK; Wirral University Teaching Hospitals (WUTH) and the Royal Wolverhampton (RWT) NHS Trusts using electronic data records. We evaluated the predictors of overnight stay among demographics, indication of surgery, as well as the predictors of conversion to open surgery, which absolutely resulted in unexpected admission.
RESULTS: Nine hundred and thirteen patients were included in this study. Increased age, female gender and anesthesia ASA III grade patients were found to be predictors of unexpected admission (p < 0.001). In addition, the presence of acute cholecystitis and CBD stones as indications for surgery predicted overnight stay as well (p < 0.001). Moreover, age and the presence of choledocholithiasis/cholangitis (post ERCP/ passes out stones) were associated with conversion to open surgery, which resulted in 100% overnight stay (p = 0.013, p = 0.004, respectively), where older patients and those who had CBD stones had 1.05 times and 6.79 times higher odds of conversion, respectively. Furthermore, increased age and male gender were more likely to have a drain inserted (p = 0.004, p < 0.001, respectively).
CONCLUSION: Although many of the predictors of overnight stay insertion were non-modifiable risks like age, gender and ASA grade, strictly following the guidelines concerning the management of postoperative symptoms like pain, nausea and vomiting as well as the prioritisation of day-cases in the operative list may play a role in avoiding overnight stay. Nevertheless, these factors did not significantly alter the outcomes in our study.
MATERIALS AND METHODS: This was a retrospective study involving 913 patients who underwent intended day-case LC between 2020 and end of 2023, in two centers in the UK; Wirral University Teaching Hospitals (WUTH) and the Royal Wolverhampton (RWT) NHS Trusts using electronic data records. We evaluated the predictors of overnight stay among demographics, indication of surgery, as well as the predictors of conversion to open surgery, which absolutely resulted in unexpected admission.
RESULTS: Nine hundred and thirteen patients were included in this study. Increased age, female gender and anesthesia ASA III grade patients were found to be predictors of unexpected admission (p < 0.001). In addition, the presence of acute cholecystitis and CBD stones as indications for surgery predicted overnight stay as well (p < 0.001). Moreover, age and the presence of choledocholithiasis/cholangitis (post ERCP/ passes out stones) were associated with conversion to open surgery, which resulted in 100% overnight stay (p = 0.013, p = 0.004, respectively), where older patients and those who had CBD stones had 1.05 times and 6.79 times higher odds of conversion, respectively. Furthermore, increased age and male gender were more likely to have a drain inserted (p = 0.004, p < 0.001, respectively).
CONCLUSION: Although many of the predictors of overnight stay insertion were non-modifiable risks like age, gender and ASA grade, strictly following the guidelines concerning the management of postoperative symptoms like pain, nausea and vomiting as well as the prioritisation of day-cases in the operative list may play a role in avoiding overnight stay. Nevertheless, these factors did not significantly alter the outcomes in our study.