Is standardized care feasible in the emergency setting? A case matched analysis of patients undergoing laparoscopic cholecystectomy.

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State: Public
Version: Final published version
Serval ID
serval:BIB_5C951FAA1FBC
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Is standardized care feasible in the emergency setting? A case matched analysis of patients undergoing laparoscopic cholecystectomy.
Journal
BMC surgery
Author(s)
Grass F., Cachemaille M., Blanc C., Fournier N., Halkic N., Demartines N., Hübner M.
ISSN
1471-2482 (Electronic)
ISSN-L
1471-2482
Publication state
Published
Issued date
01/12/2016
Peer-reviewed
Oui
Volume
16
Number
1
Pages
78
Language
english
Notes
Publication types: Comparative Study ; Journal Article ; Observational Study
Publication Status: epublish
Abstract
Immediate laparoscopic cholecystectomy is the accepted standard for the treatment of acute cholecystitis. The aim of the present study was to evaluate the feasibility of a standardized approach with tailored care maps for pre- and postoperative care by comparing pain, nausea and patient satisfaction after elective and emergent laparoscopic cholecystectomy.
From January 2014 until April 2015, data on pain and nausea management were prospectively recorded for all elective and emergency procedures in the department of visceral surgery. This prospective observational study compared consecutive laparoscopic elective vs. emergency cholecystectomies. Visual analogue scales (VAS) were used to measure pain, nausea, and satisfaction from recovery room until 96 hours postoperatively.
Final analysis included 168 (79%) elective cholecystectomies and 44 (21%) emergent procedures. Demographics (Age, gender, BMI and ASA-scores) were comparable between the 2 groups. In the emergency group, patients did not receive anxiolytic medication (0% vs.13%, p = 0.009) and less postoperative nausea and vomiting (PONV) prophylaxis (77% vs. 97% p = <0.001). Perioperative pain management was similar in terms of opioid consumption (median amount of fentanyl 450ug [IQR 350-500] vs. 450ug [375-550], p = 0.456) and wound infiltration rates (24% vs. 25%, p = 0.799). Postoperative consumption of paracetamol, metamizole and opiod medications were similar between the 2 groups. VAS scores for pain (p = 0.191) and nausea (p = 0.392) were low for both groups. Patient satisfaction was equally high in both clinical settings (VAS 8.5 ± 1.1 vs. 8.6 ± 1.1, p = 0.68).
A standardized pathway allows equally successful control of pain and nausea after both elective and emergency laparoscopic cholecystectomy. This study was retrospectively registered by March 01, 2016 in the following trial register: www.researchregistry.com (UIN researchregistry993).

Keywords
Adult, Aged, Cholecystectomy, Laparoscopic/standards, Cholecystitis, Acute/surgery, Critical Pathways, Elective Surgical Procedures/standards, Emergencies, Feasibility Studies, Female, Humans, Male, Middle Aged, Pain Measurement, Pain, Postoperative, Patient Satisfaction, Postoperative Nausea and Vomiting, Prospective Studies
Pubmed
Open Access
Yes
Create date
12/12/2016 21:21
Last modification date
20/08/2019 15:15
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