Unplanned readmission and outpatient workup 90-days after cholecystectomy in adults

Abstract

Aim: The majority of patients with persistent postoperative pain are caused by a change in the indications and timing of cholecystectomy due to a lack of evidence and different views among surgeons. We purposed to identify the relation of preoperative patients’ characteristics and postoperative readmission after laparascopic cholecystectomy Material and Methods: Between June 2015 and June 2018, 710 consecutive patients who were admitted for laparoscopic cholecystectomy were included in the study. Based on database the following factors were analysed: gender, age, American Society of Anesthesiologists classification, body mass index, Visual Analog Scale (VAS)-scale prior to operation (intensity of abdominal pain, scored on a visual score of 0–10), duration of symptoms and existence of abdominal pain. Results: There were 472 men (66.5%) and 238 women (33.5%). The median age was 51.0 (range 18-79) years. Indications for laparoscopic cholecystectomy were as follows: choleystolithiasis 452 (63.7%), acute cholecystitis 140 (19.8%), chronic cholecystitis 105 (14.7%) and sludge 13 (1.8%). The following preoperative incidence of dispeptic and colonic symptoms were as: abdominal pain n=137 (19.3%), nousea n=119 (16.8%), vomiting n=86 (12.1%), heartburn n=79 (11.1%), early satiety 80 (11.3%), bloating n=151 (21.3%), food intolerance n=62 (8.7%), constipation n=73 (10.3%), diarrhea 60 (8.5%), back pain n=307 (43.2%). Readmission was present in 108 (15.2%) of the 710 patients due to added examination for persistent abdominal pain after laparascopic cholecystectomy. The cause of readmission were gallstone related (n=16, 2.2%), surgery related (n=7, 1.0%), other diagnosis (n=30, 12.0%), nonspesific abdominal pain (n=55, 7.7%) respectively. Number of readmission were as follows: 1 (n=59, 54.6%), 2 (n=39, 36.1%), 3 (n=10, 9.3%). Conclusions: The main causes of readmission were associated with gastrointestinal symptoms other than gallstone or surgery related. Before accepting patients for cholecystectomy, doctors should discover and help realistic expectations.