Whilst patient satisfaction and anxiety was not formally assessed

Whilst patient satisfaction and anxiety was not formally assessed in the present study, there is no clear evidence from randomised trials of an increase in anxiety following day-case surgery [5]. Indeed one study found an increased anxiety in those patients no randomised to overnight stay [4]. Likewise initial concerns regarding the detection and management of complications in patients discharged on the day of surgery, particularly postoperative bleeding or bile duct injury, have also been unfounded [11]. Major bleeding is uncommon and bile duct injury is predominantly detected at the time of surgery or several days later. The introduction of a telephone follow-up service is therefore proposed at our institution in order to examine patient satisfaction, anxiety, and complication rates as part of a future study.

Readmission rates following day-case cholecystectomy remained relatively unchanged during the study period at around 5 to 7 per cent. This appears higher than the 2 to 3 per cent rate reported in other series [5, 9, 12], however since individual patient data relating to these readmissions was not formally analysed, the reasons for this disparity remain unclear. The overall conversion rates in this study of 6.1 and 14.5 per cent following elective and emergency laparoscopic cholecystectomy, respectively, were comparable to those reported nationally [13, 14]. However since 2008 these rates have fallen further to 3.1 and 10.5 per cent, respectively. This is likely to have arisen as a consequence of more cholecystectomies being performed by the five specialist upper gastrointestinal surgeons.

Whilst cholecystectomy during index admission with cholecystitis is associated with no significant difference in complication rate or conversion rate [15], it is known to reduce costs, in part due to minimising patient readmission whilst awaiting an elective procedure [1]. Indeed the estimated cost of a patient admitted with acute cholecystitis and treated conservatively is ��1,875. Despite this, less than 15 per cent of cholecystectomies were performed during an emergency admission in the present study, which is comparable to that reported nationally [14, 16]. Future plans to implement an emergency gallbladder service would facilitate an increase in this proportion. This study reports the findings of a gallbladder service involving 13 surgeons.

There is likely to have been variation in practice due to no clear standardisation of operative technique. Anaesthetic and postoperative analgesia regimes may have varied according to anaesthetist preference and a standardised gallbladder anaesthetic pathway was not introduced until after completion of this study. Postoperative complications rates are not reported here since Entinostat these were not directly measured. Less than 50% of patients returned the patient questionnaire and therefore results must be interpreted with caution.

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