An evaluation of local 30-day readmissions following laparoscopic cholecystectomy

Abstract Background Laparoscopic cholecystectomy, both elective and acute, is a commonly performed operation in general surgery. Good post-operative outcomes are important for patient physical and mental wellbeing. For example, complications can result in physical harm and abdominal pain can cause distress and anxiety. Patient anxiety can also result from symptoms which may not have a clinically significant or concerning cause. 30-day hospital readmission rates post-surgery are considered by some as a measure of quality of care. This study assessed 30-day readmissions following laparoscopic cholecystectomy at our local hospital and the investigation and management of these. Methods Clinical patient data software was used to obtain the details of all patients undergoing acute and elective laparoscopic cholecystectomy over a 4 month period, from January 2022 to the beginning of May 2022. Pre-, intra- and post-operative data was collated. Post-operative data incorporated the presenting complaints, investigations and management of patients re-presenting within 30 days of discharge from our hospital. Results 150 laparoscopic cholecystectomies were performed over 4 months. There were 12 30-day readmissions (8%), 4 elective and 8 acute patients. Presenting complaints included abdominal and chest pain. Investigations included blood tests (10 patients, 83%), ultrasound abdomen (1 patient, 8.3%), CTAP or CTPA (7 patients, 58.3%), and MRCP (1 patient, 8.3%). CTPA scans were negative for pulmonary emboli. 3 patients (2%) with gallbladder fossa collections were discharged with antibiotics. 2 patients (1.3%) required re-laparoscopy and washout in theatre for bile leak (no CBD injury). 1 patient (8.3%) required ERCP for a distal CBD stone. Overall, 4 patients (2.7%) required inpatient admission. Conclusions This study found that only a third of patients reattending within 30 days required inpatient admission, which was not unexpected. However, although most patients did not require admission, arguably the investigations performed were essential to establish this. For example, although CTPA scans did not reveal pulmonary emboli, this was a necessary investigation in the post-operative obese patient with chest pain. That said, a more effective system of triage, for example face-to-face evaluation by GPs or A&E doctors and avoidance of surgical referral without clinical assessment, is suggested to prevent inappropriate referrals, such as antibiotic skin reactions and wound bruising.