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LAPAROSCOPIC CHOLECYSTECTOMY: IMPLEMENTATION OF A CLINICAL PATHWAY

Department of Anesthesia and Surgery, McGill University Health Center, 1650 Cedar Avenue, Montreal, Quebec, Canada, H3G 1A4

INTRODUCTION

Laparoscopic cholecystectomy has rapidly replaced the open procedure and can be performed on an outpatient basis [1,2]. We conducted a retrospective analysis to establish the effect of implementing a clinical pathway on the rate of unanticipated admission following outpatient laparoscopic cholecystectomy.

METHODS

Three hundred and ninety patients who underwent laparoscopic cholecystectomy from November 1999 till August 2002 were divided into two groups; group A, before the implementation of the clinical pathway (n=113, between Nov. 1999 and Dec. 2000) and group B, after the establishment of the pathway (n=285, between Jan. 2001 and Aug. 2002). The clinical pathway was standardized from hospital admission to discharge and included precise instructions for patients and staff with written guidelines for postoperative admission. All demographic and clinical data on perioperative surgical, and anesthesia and analgesia care were recorded. Reasons for unanticipated postoperative hospital admission were documented.

RESULTS

Seventy four percent (82 out of 113) of patients in group A were admitted to the surgical ward at the end of the procedure. Forty two out of 82 patients (52%) were admitted with no obvious reason. For the other 42 patients admitted, the most common reasons were: medical (28.5%), pain (26%), urinary retention (23.8%), surgical (14.2%), PONV (4.7%) and social (2.3%). Following the implementation of the clinical pathway, the rate of admission dropped to 8% (23 out of 285 patients). Most common reasons were: surgical (47.8%), PONV (21.7%), pain (13%), urinary retention (10%), medical (8.6%) and social (4.3%).

DISCUSSION

Although the introduction of a clinical pathway reduced the rate of admission following laparoscopic cholecystectomy, perioperative efforts need to be made to decrease even further the anesthesia and surgery-related complications.

REFERENCE

1 Calland JF. Ann Surg 2001; 233: 704–15[Medline]

2 Lau H. Arch Surg 2001; 136: 1150–3[Abstract/Free Full Text]

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