Day-case versus overnight stay in laparoscopic cholecystectomy.

BACKGROUND Although day-case elective laparoscopic cholecystectomy can save bed costs, its safety remains to be established. OBJECTIVES To assess the safety and benefits of day-case surgery compared to overnight stay in patients undergoing elective laparoscopic cholecystectomy. SEARCH STRATEGY We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until February 2007 for identifying randomised trials using search strategies. SELECTION CRITERIA Only randomised clinical trials, irrespective of language, blinding, or publication status, comparing day-case and overnight stay in elective laparoscopic cholecystectomy were considered for the review. DATA COLLECTION AND ANALYSIS We collected the data on the characteristics of the trial, methodological quality of the trials, morbidity, prolonged hospitalisation, re-admissions, pain and quality of life from each trial. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. For each outcome we calculated the relative risk, weighted mean difference, or standardised mean difference with 95% confidence intervals (CI) based on available case-analysis. MAIN RESULTS Five trials with 429 patients randomised to the day-case group (215) and overnight stay group (214) were included in the review. Four of the five trials were of low risk of bias regarding randomisation and follow up, but all lacked blinding. The trials recruited 49% of patients undergoing cholecystectomy. The selection criteria varied, but most included only patients without other diseases. The patients were living in easy reach of the hospital and with a responsible adult to take care of them. On the day of surgery, 81% of day-case patients were discharged. The drop-out rate after randomisation varied from 6.5% to 12.7%. There was no significant difference between day-case and overnight stay group as regards to morbidity, prolongation of hospital stay, re-admission rates, pain, quality of life, patient satisfaction and return to normal activity and work. AUTHORS' CONCLUSIONS Day-case elective laparoscopic cholecystectomy seems to be a safe and effective intervention in selected patients (with no or minimal systemic disease and within easy reach of the hospital) with symptomatic gallstones. Because of the decreased hospital stay, it is likely to save costs.

[1]  Douglas G Altman,et al.  Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study , 2008, BMJ : British Medical Journal.

[2]  K. Gurusamy,et al.  Meta‐analysis of randomized controlled trials on the safety and effectiveness of day‐case laparoscopic cholecystectomy , 2008, The British journal of surgery.

[3]  M. Parvaiz,et al.  Letter: randomized clinical trial of day‐care versus overnight‐stay laparoscopic cholecystectomy (Br J Surg 2006; 93: 40–45) , 2006, The British journal of surgery.

[4]  L. Lundell,et al.  Randomized clinical trial of day‐care versus overnight‐stay laparoscopic cholecystectomy , 2006, The British journal of surgery.

[5]  P. Sedman,et al.  Prospective comparison of ambulatory with inpatient laparoscopic cholecystectomy: outcome, patient preference and satisfaction , 2004 .

[6]  O. Mjåland,et al.  [Cholecystectomy in Norway 1990-2002]. , 2004, Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke.

[7]  R. Rege,et al.  A nationwide study of conversion from laparoscopic to open cholecystectomy. , 2004, American journal of surgery.

[8]  P. Selas,et al.  Laparoscopic cholecystectomy and outpatient surgery. , 2004 .

[9]  E. Kullman,et al.  Development of symptoms and complications in individuals with asymptomatic gallstones , 2004, The British journal of surgery.

[10]  Alexander J Sutton,et al.  What to add to nothing? Use and avoidance of continuity corrections in meta-analysis of sparse data. , 2004, Statistics in medicine.

[11]  A. Shamiyeh,et al.  Laparoscopic cholecystectomy: early and late complications and their treatment , 2004, Langenbeck's Archives of Surgery.

[12]  Pamela Royle,et al.  LITERATURE SEARCHING FOR RANDOMIZED CONTROLLED TRIALS USED IN COCHRANE REVIEWS: RAPID VERSUS EXHAUSTIVE SEARCHES , 2003, International Journal of Technology Assessment in Health Care.

[13]  G. Harinath,et al.  A survey of the timing and approach to the surgical management of cholelithiasis in patients with acute biliary pancreatitis and acute cholecystitis in the UK. , 2003, Annals of the Royal College of Surgeons of England.

[14]  Douglas G. Altman,et al.  The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials , 2001, The Lancet.

[15]  S. Thompson,et al.  Quantifying heterogeneity in a meta‐analysis , 2002, Statistics in medicine.

[16]  R. Burney,et al.  Ambulatory and admitted laparoscopic cholecystectomy patients have comparable outcomes but different functional health status , 2002, Surgical Endoscopy And Other Interventional Techniques.

[17]  Dirksen Cd,et al.  [Ambulatory laparoscopic cholecystectomy is as effective as hospitalization and from a social perspective less expensive: a randomized study]. , 2001 .

[18]  Christian Gluud,et al.  Reported Methodologic Quality and Discrepancies between Large and Small Randomized Trials in Meta-Analyses , 2001, Annals of Internal Medicine.

[19]  M. Rosen,et al.  Cost-effectiveness of Ambulatory Laparoscopic Cholecystectomy , 2001, Surgical laparoscopy, endoscopy & percutaneous techniques.

[20]  D. Moher,et al.  The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials , 2001, The Lancet.

[21]  J. Young,et al.  Recovery following laparoscopic cholecystectomy in either a 23 hour or an 8 hour facility. , 2001, Journal of quality in clinical practice.

[22]  S D Walter,et al.  A comparison of methods to detect publication bias in meta‐analysis , 2001, Statistics in medicine.

[23]  R. Padbury,et al.  A prospective randomized trial of day-stay only versus overnight-stay laparoscopic cholecystectomy. , 1999, The Australian and New Zealand journal of surgery.

[24]  E. Tsimoyiannis,et al.  Intraperitoneal normal saline and bupivacaine infusion for reduction of postoperative pain after laparoscopic cholecystectomy. , 1998, Surgical laparoscopy & endoscopy.

[25]  O. Mjåland,et al.  Cholecystectomy rates, gallstone prevalence, and handling of bile duct injuries in Scandinavia , 1998, Surgical Endoscopy.

[26]  D. Gouma,et al.  Laparoscopic cholecystectomy: day-care versus clinical observation. , 1998, Annals of surgery.

[27]  D. Cook,et al.  Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? , 1998, The Lancet.

[28]  J. de Haes,et al.  Day care or hospital admission after laparoscopic cholecystectomy, a prospective randomized trial , 1998 .

[29]  G. Smith,et al.  Bias in meta-analysis detected by a simple, graphical test , 1997, BMJ.

[30]  J. Ahlberg,et al.  Prevalence of gallstone disease in a Swedish population. , 1995, Scandinavian journal of gastroenterology.

[31]  R. J. Hayes,et al.  Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. , 1995, JAMA.

[32]  G. Fullarton,et al.  Prospective audit of the introduction of laparoscopic cholecystectomy in the west of Scotland. West of Scotland Laparoscopic Cholecystectomy Audit Group. , 1994, Gut.

[33]  D J Newell,et al.  Intention-to-treat analysis: implications for quantitative and qualitative research. , 1992, International journal of epidemiology.

[34]  T. Jørgensen.  Prevalence of gallstones in a Danish population. , 1987, American journal of epidemiology.

[35]  D L Demets,et al.  Methods for combining randomized clinical trials: strengths and limitations. , 1987, Statistics in medicine.

[36]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[37]  A. Sharmaa,et al.  Prospective comparison of ambulatory with inpatient laparoscopic cholecystectomy : outcome , patient preference and satisfaction , 2004 .

[38]  J. Samarütel,et al.  Postoperative pain relief after laparoscopic cholecystectomy: a randomised prospective double-blind clinical trial. , 2003, Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society.

[39]  M. Curet,et al.  Laparoscopic cholecystectomy: Outpatient vs inpatient management , 2002 .

[40]  J. Keulemans,et al.  Laparoscopische cholecystectomie in dagbehandeling even effectief als tijdens opname en goedkoper: een gerandomiseerd onderzoek , 1999 .