Clerical error, particularly with respect to patients being liste

Clerical error, particularly with respect to patients being listed on afternoon operating lists, resulted in a number of patients suitable for day-case surgery requiring an overnight stay. This issue has been previously selleck chem Ganetespib identified in randomised trials of laparoscopic day-case cholecystectomy versus overnight stay [9]. Following the interim audit in 2008, patients suitable for day-case were predominantly scheduled on a morning list or first on the afternoon list, which resulted in a substantial increase in day-case rates from 30 to over 60 per cent. Increasing the duration of daycase unit opening hours and ensuring patients are discharged according to criteria that do not include set time periods, may enhance this further.

Whilst patient satisfaction and anxiety was not formally assessed in the present study, there is no clear evidence from randomised trials of an increase in anxiety following day-case surgery [5]. Indeed one study found an increased anxiety in those patients randomised to overnight stay [4]. Likewise initial concerns regarding the detection and management of complications in patients discharged on the day of surgery, particularly postoperative bleeding or bile duct injury, have also been unfounded [11]. Major bleeding is uncommon and bile duct injury is predominantly detected at the time of surgery or several days later. The introduction of a telephone follow-up service is therefore proposed at our institution in order to examine patient satisfaction, anxiety, and complication rates as part of a future study.

Readmission rates following day-case cholecystectomy remained relatively unchanged during the study period at around 5 to 7 per cent. This appears higher than the 2 to 3 per cent rate reported in other series [5, 9, 12], however since individual patient data relating to these readmissions was not formally analysed, the reasons for this disparity remain unclear. The overall conversion rates in this study of 6.1 and 14.5 per cent following elective and emergency laparoscopic cholecystectomy, respectively, were comparable to those reported nationally [13, 14]. However since 2008 these rates have fallen further to 3.1 and 10.5 per cent, respectively. This is likely to have arisen as a consequence of more cholecystectomies being performed by the five specialist upper gastrointestinal surgeons.

Whilst cholecystectomy during index admission with cholecystitis is associated with no significant difference in complication rate or conversion rate [15], it is known to reduce costs, in part due to minimising patient readmission whilst awaiting an elective procedure Brefeldin_A [1]. Indeed the estimated cost of a patient admitted with acute cholecystitis and treated conservatively is ��1,875. Despite this, less than 15 per cent of cholecystectomies were performed during an emergency admission in the present study, which is comparable to that reported nationally [14, 16].

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