Selection criteria for laparoscopic cholecystectomy in an ambulatory care setting

Background: The ambulatory care center offers patient convenience and reduced costs after uneventful laparoscopic cholecystectomy. Methods: A prospectively accumulated database of 1,750 cholecystectomies performed by one surgeon in a hospital setting was analyzed to test criteria for ambulatory cholecystectomy. Proposed criteria included age less than 65, absence of upper abdominal operations, and elective operations in healthy patients at low risk for common bile duct stones. Results: Of 1,750 cholecystectomies, only 605 patients met all criteria for outpatient care. Discharge (from the in-hospital setting) was accomplished within 24 h of operation in 92% (first 3 years) and 98% (last 4 years) of selected cases. Only one patient (0.2%, 1/605) was converted to an open procedure; another was readmitted 30 h postoperatively with hemorrhage from the liver bed. Conclusions: Laparoscopic cholecystectomy can be performed safely in an ambulatory care setting, given careful selection and education of patients and documented experience of the surgical team.