Successful Discharge Rate of One-Day Laparoscopic Cholecystectomy Surgery by Modified Post-Anesthetic Discharge Scoring System in Siriraj Hospital

Abstract

Background: Ambulatory laparoscopic cholecystectomy (LC) could be done safely. One day surgery (ODS) is a new program supported by Thai government. It is to discharge the patient within the same day of surgery or within 24 hours from incision time. A modified post-anesthesia discharge scoring system (PADSS) is recommended. Objective: To determine the successfully discharge rate (PADSS = 9,10) within 24 hours from incision time in normal practice LC without specific ODS protocol and to compare the anesthetic and surgical factors between the patients with PADSS = 9,10 and the patients with PADSS score < 9. Methods: The prospective cohort, non-allocation study in elective LC from 18 years in Siriraj hospital in February-March 2020. Demographic, preoperative intraoperative and postoperative data were reviewed from the hospital chart. PADSS evaluation were done at 24 hours after incision. The number of patients with PADSS = 9,10 reported by percentage and 95% CI. Comparing factors between two groups using a t-test. Results: Patients with PADSS = 9,10 were found 44 from 55 cases (80.0%) (95%CI 67-89.6%): 100.0%, 87.0% and 65.2% of ASA I, II and III, respectively. Patient’s age (59.6±13.8 years vs 71.7±16.0 years, P=0.016), operative time (84.4±34.6 min vs 112.3±35.2 min, P=0.021) and anesthetic duration (152.3±36.6 min vs 121.5±36.8 min, P=0.016) in the PADSS score 9,10 group were significantly lower than in the PADSS score < 9 group. Conclusions: In normal practice of elective LC in Siriraj Hospital, we could discharge patients within 24 hours after incision by using modified PADSS (score = 9,10) in 80.0% of cases. The major problem of delayed discharge time was ambulation. Important factors are ASA physical status, age, operative time, and anesthetic time.