Day case laparoscopic cholecystectomy: barriers to successful discharge – a single center retrospective study

Background: Day case laparoscopic cholecystectomy (DCLC) is a known alternative to overnight stay procedure and is sporadically implemented in tertiary hospitals in Australia. Despite strict protocol adherence, some patients required admission post-operatively. We seek to identify the barriers to successful discharge for DCLC in our institution- a non-tertiary hospital in Victoria. Methods: A retrospective study of patients who underwent elective DCLC during a 12-month period in 2023 and 2024 was performed. Collected data include patient’s demographics, operator experience and post-operative complications. Comparative analysis and multivariable logistic regression performed to identify associations between exposure variables and discharge failure, adjusted for age and sex. Results: There were 77 (55 females, 22 males) patients with mean age of 44.2 (SD: 11.9). Of these, 60% were successfully discharged on the same day. The most common reason for unplanned overnight admissions was due to symptoms in recovery (35%). There is a significant association between discharge failure and high BMI ( P = 0.047; OR: 3.41, CI: 1.02–11.4). Conclusion: DCLC is a feasible alternative to overnight stay procedure in non-tertiary hospitals. However, a higher rate of failure is seen in patients with significant PONV symptoms and in obese patients (BMI ≥ 30). Prompt reviews of immediate post-operative symptoms are important to reduce unplanned overnight admission. Revision of patient selection criteria and post-operative pathway algorithm are necessary to ensure successful implementation. Future studies with a larger sample size and validated objective measurement tools of patient symptoms are necessary to validate these preliminary findings.