Laparoscopic cholecystectomy-comparison of early postoperative results in an Australian rural centre and a German university hospital

Matthias Wichmann, Reinhold Lang, Eben Beukes, Shaukat Esufali, Karl Jauch, Tanyia Huttl, Thomas Huttl

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    3 Citations (Scopus)

    Abstract

    Background Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstone disease. Cultural as well as organisational differences can result in significant variations of postoperative length of stay. Aim of the present study The aim of this study is to evaluate whether differences in postoperative length of stay and early postoperative outcome can be observed by comparison of an Australian rural centre and a German university hospital. Results Between February 2006 and August 2007 (18months), 359 patients (140 Australia, 219 Germany) underwent laparoscopic cholecystectomy. Mean patient age was 50.4±1.5 and 53.5±1.0 years, respectively. Seventy-seven percent of the Australian and 62% of the German patients were female. Twenty-one percent and 20% of the procedures were emergencies, respectively. Median American Society of Anaesthesiologists score of all patients was two. The conversion rate was 8% in both centres. A 4% complication rate was observed in Australia (N=5, 3× bile leak, 1× postoperative bleeding and 1× wound infection) as opposed to 3% in Germany (N=7, 2× bile leak, 2× postoperative bleeding and 3× wound infection). Postoperative length of stay in Australia was 1.8±0.1 days (median 1 day) and was significantly longer in patients after emergency surgery (1.6±0.1 versus 2.6±0.3 days, p<0.018). Postoperative length of stay in Germany was 3.7±0.2 days (median 3 days), and no significant differences were observed when elective and emergency procedures were compared (3.5±0.2 versus 3.9±0.5 days, p>0.05). Comparison of treatment results indicates a significantly shorter postoperative stay in Australia (3 days versus 1 day, p<0.001). Discussion/conclusion In rural Australia, a median postoperative stay of 1 day after laparoscopic cholecystectomy can be safely achieved. Postoperative length of stay is significantly longer in the German setting with otherwise comparable patients and surgical techniques. Simple changes of pre- and postoperative management of elective as well as emergency laparoscopic cholecystectomy will allow, for substantial cost savings, for the German health system.

    Original languageEnglish
    Pages (from-to)255-260
    Number of pages6
    JournalLANGENBECKS ARCHIVES OF SURGERY
    Volume395
    Issue number3
    DOIs
    Publication statusPublished - Mar 2010

    Keywords

    • Complications
    • Laparoscopic cholecystectomy
    • Length of stay
    • Outcome
    • Systems of patient care

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