OUTPATIENT LAPARASCOPIC SURGERY TRIAL (OLST)

共有99例患者入组了现已完成的研究。两 患者从腹腔镜胆囊切除术转为开腹胆囊切除术 由于未能获得良好的手术暴露，因此 被排除在研究之外。 第三例患者的腹腔镜手术 在技术上有困难，需要放置封闭的吸引引流管 在手术结束后的肝下间隙 该患者 手术当天不适合出院回家，也被排除在外 从研究中。 所有96例患者的术中过程均顺利。 除恶心呕吐外，无术后并发症。 11例（11/96或12%）患者发生术后恶心， 需要药物治疗的呕吐。在11例PONV患者中， 需要治疗，3人因 无法耐受口服相关的平均费用 门诊手术的费用是2131美元。 24小时的平均收费 同期住院手术费用为3878美元， 平均净节省1747美元。 我们的研究表明，腹腔镜胆囊切除术可以进行 更安全，更经济，更有效地在门诊基础上，并导致了 管理层的变化。 我们目前正在对患者进行前瞻性随访 在计划手术当天出院回家。

A total of 99 patients were enrolled into the now completed study. Two of the patients were converted from laparoscopic to an open cholecystectomy due to failure to obtain good surgical exposure, and were therefore excluded from the study. The laparoscopic procedure in a third patient was technically difficult and required placement of a closed suction drain in the subhepatic space at the end of the procedure. This patient was not eligible for discharge home the day of surgery and was also excluded from the study. All 96 patients had an uneventful intraoperative course. There were no postoperative complications other than nausea and vomiting. Eleven (11/96 or 12%) patients experienced postoperative nausea and vomiting requiring pharmacologic therapy. Of the 11 patients with PONV requiring treatment, 3 required an additional day of hospitalization due to the inability to tolerate oral intake. The average charges associated with an outpatient procedure were $2131. The average charge for a 24 hour inpatient procedure during the same time period was $3878, yielding an average net potential savings of $1747. Our study suggests that laparoscopic cholecystectomy can be performed safely and more cost-effectively on an outpatient basis and has led to a change in management. We are currently following patients prospectively who are discharged home the same day as the planned surgery.