OUTPATIENT LAPARASCOPIC SURGERY TRIAL (OLST)

共有99名患者参加了这项现已完成的研究。其中两个 患者从腹腔镜手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，需要放置一个封闭的吸引管 在手术结束时，在肝下间隙。这位病人是 手术当天没有资格出院，也被排除在外 从这项研究中。所有96名患者的术中病程都很顺利。 术后除恶心呕吐外，无其他并发症发生。 11例(11/96或12%)患者术后出现恶心和 呕吐需要药物治疗。在11名PONV患者中 需要治疗的有3人需要额外住院一天 无法忍受口服的原因。相关的平均费用 门诊费是2131美元。24小时的平均收费 同期的住院费用为3878美元，产生了 平均净潜在节省1747美元。 我们的研究表明，可以进行腹腔镜胆囊切除术。 在门诊的基础上安全和更具成本效益，并导致 管理层的变动。我们目前正在前瞻性地跟踪观察患者。 他们在计划手术的同一天出院。

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.