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Open Access 01-12-2016 | Research article

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

Authors: Fabian Grass, Matthieu Cachemaille, Catherine Blanc, Nicolas Fournier, Nermin Halkic, Nicolas Demartines, Martin Hübner

Published in: BMC Surgery | Issue 1/2016

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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)

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Title: Is standardized care feasible in the emergency setting? A case matched analysis of patients undergoing laparoscopic cholecystectomy
Authors: Fabian Grass
Matthieu Cachemaille
Catherine Blanc
Nicolas Fournier
Nermin Halkic
Nicolas Demartines
Martin Hübner
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Surgery / Issue 1/2016
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-016-0194-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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