Evaluación de la colecistectomia laparoscópica en régimen ambulatorio. Validación de un sistema predictivo de selección de pacientes.
Introduction: The aim of our study was to review our experience and to determine a predictive model of factors for unanticipated admissions after ambulatory laparoscopic cholecystectomy (LC).
Material and Methods: Between January 1999 and June 2003, 410 consecutive LC were performed as outpatient procedures. We performed univariate analysis and logistic regression models of preoperative and intraoperative variables. Scoring system developed allowed calculating the ambulatorization probability of LC in each patient. Validation and calibration of the model were realized by means of Hosmer-Lemeshow test.
Results: 363 patients were strictly ambulatory (86.8%). Forty-two patients required overnight admission (10.2%), most of them due to social factors, and 5 patients were admitted. Predictive factors related to overnight stay or admission were: age of patient over 65 years (p=0.021; OR=2.225; 95%CI: 1.130-4.381), operation duration superior to 60 minutes (p=0.046; OR=2.403; 95%CI: 1.106-5.685), and dissection difficulty intraoperative score superior to 6 (p=0.034; OR=3.063; 95%CI: 1.086-8.649). Right classification index of the predictive system was 91.7% reaching a sensibility of 99.7% and specificity of 31.9%. Protocolized tests about quality grade obtained were completed in 100 % of the cases. Global satisfaction of the patient was 86.2%.
Conclusions: Outpatient LC is safe and feasible. Age of the patient, operation duration and complexity of surgical dissection during LC are independent factors influencing ambulatorization rate.
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Advisor:Espí Macias, Alejandro; Planells Roig, Manuel; Serralta Serra, Alfonso
School:Universitat de València
Source Type:Master's Thesis
Date of Publication:12/14/2007