OUTPATIENT LAPARASCOPIC SURGERY TRIAL (OLST)

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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.