Predictive factors for unanticipated admissions after ambulatory laparoscopic cholecystectomy

Hypothesis: Analysis of the causes of unanticipated admission after ambulatory laparoscopic cholecystectomy may permit the identification of predictive clinical factors for postoperative admission. Design: Univariate and multivariate analyses of clinical variables associated with unplanned admission in a retrospective case-control series of ambulatory laparoscopic cholecystectomies. Setting: A major university-affiliated teaching hospital. Patients: Seven hundred thirty-one consecutive patients who underwent ambulatory laparoscopic cholecystectomies between January 1, 1996, and December 31, 1999. Intervention: Ambulatory laparoscopic cholecystectomy. Main Outcome Measures: Unplanned postoperative admissions. Univariate and multivariate analyses of 19 clinicopathologic factors were performed to identify independent predictive factors for these admissions. Results: Seven hundred six patients were discharged on the day of operation. The remaining 25 required admission because of pain (n = 10), nausea and vomiting (n = 6), retention of urine (n= 5), patient preference (n = 3), and medical observation (n= 1), giving an unanticipated admission rate of 3.4%. Significant factors. associated with unplanned admission included operative duration of longer than 60 minutes and thickened gallbladder wall on ultrasonographic and pathological findings. By means of logistic regression, length of operation was the only independent predictive factor. Operative time exceeding 60 minutes incurred a 4-fold increased risk for unanticipated admission. Conclusions: Operative duration was the best predictive factor for unplanned admission after ambulatory laparoscopic cholecystectomy. During selection of patients for day surgery, ultrasonographic demonstration of a thickened gallbladder wall should be taken into consideration.