Elective day-case laparoscopic cholecystectomy: a formal assessment of the need for outpatient follow-up

• Published in: Annals of the Royal College of Surgeons of England 2013-11, Vol.95 (8), p.e10-e14
• Main Authors: van Boxel, GI, Hart, M, Kiszely, A, Appleton, S
• Format: Article
• Language: English
• Subjects: Antibiotics; Body mass index; Cholecystectomy; Gallbladder; Hospitals; Infections; Laparoscopy; Pain; Patient satisfaction; Postoperative period; Questionnaires; Surgery
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/rcsann.2013.95.8.e10

Introduction Elective laparoscopic cholecystectomy (LC) is performed routinely as day-case surgery. Most hospital trusts have a policy of no routine postoperative outpatient follow-up although there are no formal guidelines on this. The aim of this retrospective study was to identify the incidence of complications, the degree of symptom resolution and patient satisfaction with a view to formally appraising the need for outpatient follow-up. Methods Patients who underwent LC in the period between February 2011 and June 2012 were contacted retrospectively by telephone. A standardised questionnaire was used to ascertain the incidence of surgical site infection (SSI), other complications, symptom resolution and patient satisfaction. Results A total of 211 responses were collected. The rate of SSI was 7.6% (n=16), with the only specific risk factor being smoking (p=0.027). All other complications had a combined incidence of 7% (n=15). There was complete resolution of symptoms in 64% of patients. Of the 36% of patients with residual symptoms, 45% described abdominal discomfort or pain, 41% described reflux symptoms and 14% complained of diarrhoea. Patient satisfaction was very high (96%), yet 33% of patients visited their general practitioner postoperatively in relation to their surgery. Conclusions Patients are highly satisfied with elective day-case LC. However, SSI is not uncommon, occurring in 1 in 13 patients. Although the majority of patients experience complete symptom resolution, a significant proportion do not. In our experience, routine outpatient follow-up is not required. Nevertheless, the lack of formal follow-up may prove a missed learning opportunity, potentially resulting in inappropriate patient selection for surgery.