Day case laparoscopic cholecystectomy: Identifying patients for a 'COVID-Cold' isolated day-case unit during the pandemic. Issue 3 (March 2021)

• Record Type: Journal Article
• Authors: Hinchcliffe, Zoe; Mohamed, Imran; Lala, Anil
• Is Part Of: Journal of perioperative practice. Volume 31:Issue 3(2021)
• Page Start: 62
• Page End: 70
• Publication Date: 2021-03
• Subjects: COVID-19/ Day-case surgery/ General surgery/ Isolated day case unit/ Laparoscopic cholecystectomy; Operating room nursing -- Periodicals; 617.9192
• DOI: 10.1177/1750458920977418
• Languages: English
• ISSNs: 2515-7949

Abstract

Background: The UK practice of laparoscopic cholecystectomy has reduced during the COVID-19 pandemic due to cancellation of non-urgent operations. Isolated day-case units have been recommended as 'COVID-cold' operating sites to resume surgical procedures. This study aims to identify patients suitable for day case laparoscopic cholecystectomy (DCLC) at isolated units by investigating patient factors and unexpected admission. Method: Retrospective analysis of 327 patients undergoing DCLC between January and December 2018 at Ysbyty Gwynedd (District General Hospital; YG) and Llandudno General Hospital (isolated unit; LLGH), North Wales, UK. Results: The results showed that 100% of DCLCs in LLGH were successful; 71.4% of elective DCLCs were successful at YG. Increasing age ( p = 0.004), BMI ( p = 0.01), ASA Score ( p = 0.006), previous ERCP ( p = 0.05), imaging suggesting cholecystitis ( p = 0.003) and thick-walled gallbladder ( p = 0.04) were significantly associated with failed DCLC on univariate analysis. Factors retaining significance (OR, 95% CI) after multiple regression include BMI (1.82, 1.05–3.16; p = 0.034), imaging suggesting cholecystitis (4.42, 1.72–11.38; p = 0.002) and previous ERCP (5.25, 1.53–18.00; p = 0.008). Postoperative complications are comparable in BMI <35kg/m 2 and 35–39.9kg/m 2 . Conclusions: Current patient selection for isolated day unit is effective in ensuring safe discharge and could be further developed with greater consideration for patients with BMI 35–39.9kg/m 2 . As surgical services return, this helps identify patients suitable for laparoscopic cholecystectomy at isolated COVID-free day units.