Readmissions after laparoscopic cholecystectomy in a UK District General Hospital (original) (raw)

Abstract

Introduction

Laparoscopic cholecystectomy is the gold standard for the treatment of symptomatic gallstones and its practice as day case where possible is considered the standard over the last decade. However, readmission after surgery is recognised as a new problem.

Aim

The aim of this cohort observational study was to investigate the readmission rate in a district general hospital and identify the causes of readmission in order to explore ways by which this can be reduced or managed more cost effectively.

Method

Records of patients who had laparoscopic cholecystectomy over 6 months were retrospectively searched. Patients returning to hospital due to symptoms within 30 days of elective and emergency laparoscopic cholecystectomy were included.

Results

Three hundred and twenty-eight laparoscopic cholecystectomies were performed within the 6-month period. Twenty-two patients returned within 30 days of surgery making a readmission rate of 6.7%. Reasons for inpatient admission were abdominal pain without any underlying cause 10 (45.5%), wound infection 5 (22.7%), leg swelling 2 (9%), retained stone 1 (4.5%), bile leak 1 (4.5%), pneumonia 1 (4.5%), iatrogenic bowel injury 1 (4.5%) and back pain 1 (4.5%). Readmission rate decreased with longer duration of stay in hospital during primary admission, and 64% of patients returned to the hospital within 7 days of procedure. 50% of patients who returned with abdominal pain without any identifiable cause had a longstanding history of conditions involving chronic pain.

Conclusion

While the feared intra-abdominal complications of cholecystectomy often come to mind when assessing patients presenting with abdominal pain after surgery, non-specific abdominal pain is consistently shown to be several times more likely. A combination of patient factors and pain control techniques account for this pain. Effective multimodal pain management approach and community primary health care support in the early post-operative period could reduce readmission, save cost and improve patient experience.

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References

  1. Health and Social Care Information Centre (2015) Hospital episode statistics, admitted patient care, England—2013–2014: main procedures and interventions; 3 character. http://www.hscic.gov.uk/catalogue/PUB16719. Accessed 1 July 2016
  2. Royal College of Surgeons England (2013) Commissioning guide: gallstone disease. https://www.rcseng.ac.uk/healthcare-bodies/nscc/commissioning-guides/guide-topics. Accessed 20 Nov 2015
  3. Antakia R, Elsayed SA, Al-Jundi W, Ravi RD (2014) Day case laparoscopic cholecystectomy, room for improvement; A United Kingdom district general hospital experience. Ambul Surg 20(1):4–9
    Google Scholar
  4. Briggs CD, Irving GB, Mann CD, Cresswell A, Englert L, Peterson M, Cameron IC (2009) Introduction of a day-case laparoscopic cholecystectomy service in th UK: a critical analysis of factors influencing same-day discharge and contact with primary care providers. Ann R Coll Surg Engl 91:583–590
    Article CAS PubMed PubMed Central Google Scholar
  5. Tamhankar AP, Mazari F, Olubaniyi J, Everitt N, Ravi K (2010) Postoperative symptoms, after-care, and return to routine activity after laparoscopic cholecystectomy. J Soc Laparosc Surg 14:484–489
    Article Google Scholar
  6. Centres for Disease Control and Prevention (2016) Epi Info™. http://www.cdc.gov/epiinfo/index.html. Accessed 20 Apr 2016
  7. Ahmad NZ, Byrnes G, Naqvi SA (2008) A meta-analysis of ambulatory versus inpatient laparoscopic cholecystectomy. Surg Endosc 22:1928–1934
    Article CAS PubMed Google Scholar
  8. Farooq T, Buchanan G, Manda V, Kennedy R, Ockrim J (2009) Is early laparoscopic cholecystectomy safe after the ‘safe period’? J Laparosc Adv Surg Technol A 19:471–474
    Article Google Scholar
  9. Simsek G, Kartal A, Sevnic B, Tasci HI, Dogan S (2015) Early hospital readmission after laparoscopic cholecystectomy. Surg Laparos Endosc Percutaneous Tech 25(3):254–257
    Article Google Scholar
  10. Sanjay P, Weerakoon R, Shaikh IA, Bird T, Paily A, Yalamarthi S (2011) A 5-year analysis of readmissions following elective laparoscopic cholecystectomy. Int J Surg 9:52–54
    Article CAS PubMed Google Scholar
  11. McGrath B, Elgendy H, Chung F, Kamming D, Curti B, King S (2004) Thirty percent of patients have moderate to severe pain 24 h after ambulatory surgery: a survey of 5703 patients. Can J Anesth 51(9):886–891
    Article PubMed Google Scholar
  12. Reddy VS, Brown JD, Ku B, Gilchrist BF, Farkas DT (2015) Effect of pain medication choice on emergency room visits for pain after ambulatory laparoscopic cholecystectomy. Am Surg 81(8):826–828
    PubMed Google Scholar
  13. Loizides S, Gurusamy KS, Nagendran M, Rossi M, Guerrini GP, Davidson BR (2014) Wound infiltration with local anaesthetic agents for laparoscopic cholecystectomy. Cochrane Database Syst Rev. doi:10.1002/14651858.CD007049.pub2
    PubMed Google Scholar
  14. Gurusamy KS, Nagendran M, Guerrini GP, Toon CD, Zinnuroglu M, Davidson BR (2014) Intraperitoneal local anaesthetic instillation versus no intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy. Cochrane Database Syst Rev. doi:10.1002/14651858.CD007337.pub3
    Google Scholar
  15. CircleNothingham (2016) Post operation care. http://www.circlehealth.co.uk/locations/nottingham/patient-post-operative-survey. Accessed 27 May 2016

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Authors and Affiliations

  1. Department of General Surgery, Doncaster Royal Infirmary, Doncaster and Bassetlaw NHS Foundation Trust, Armthorpe Road, Doncaster, DN25LT, UK
    Olugbenga Awolaran, Tabitha Gana, Nehemiah Samuel & Kenneth Oaikhinan
  2. 3a Boswell Drive, Coventry, CV2 2DL, UK
    Olugbenga Awolaran

Authors

  1. Olugbenga Awolaran
  2. Tabitha Gana
  3. Nehemiah Samuel
  4. Kenneth Oaikhinan

Corresponding author

Correspondence toOlugbenga Awolaran.

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Disclosures

Mr. Awolaran, Mr. Samuel, Miss Gana and Mr. Oaikhinan have no conflicts of interest or financial ties to disclose.

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Awolaran, O., Gana, T., Samuel, N. et al. Readmissions after laparoscopic cholecystectomy in a UK District General Hospital.Surg Endosc 31, 3534–3538 (2017). https://doi.org/10.1007/s00464-016-5380-1

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