Update Course Rewind- Who to Send Home from the OR: Uncomplicated Laparoscopic Cholecystectomy Part 3

Globalcast MD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. Hello pediatric surgery family. I'm Cecilia Hijena, a research fellow from Cincinnati Children's Hospital Medical Center. Our 11th annual update course in pediatric surgery was held this past August. In this session, the surgeons discuss in round table fashion who can go home from the OR on the same day of the procedure. Today, it's stand for uncomplicated laparoscopic cholecystectomy. An uncomplicated cholecystectomy in a 16-year-old with biliary dyskinesia. I think it's really about the expectations that you set with the family up front. So I think when we communicate to families that this is a outpatient operation, you're going to come in, get your gallbladder out and go home. Families, kids do much better and the families do much better around. What postoperative complaint is most common and often prolongs hospital stays? I do think in the bladder patients we see more postoperative nausea. And what are some strategies or protocols that are followed to help get patients home on the same day? We do try to do them first case in the morning when possible. Is that makes a big difference. I tend to keep them keep an eye on them for a bit longer and some ERAS protocols recommend to do do the first operation in the morning so that you have increased the possibility of sending them home the same day. Yeah, let's look at the poll. 50% of patients are sent home from the PACU or on the same day of their procedure. And if you give them a dose of Zoran before they go, again, if you have a protocol where you're preemptively anticipating the things that might keep them there. I think that helps. So what does the evidence say? In a single center implementation of an ERAS type protocol, same day discharge went from 2% to 77%. And they saw no significant difference in 30-day ED visits. Um they saw decreased morphine equivalence, that kind of goes hand in hand with an ERAS protocol. Additionally, they found that overnight hospital stays increased with later OR times, higher ASA scores, and longer operative times such as those for mortality in gold bladders. What is appropriate for postoperative analgesia? We send our patients home from the PACU with just Tylenol and Motrin with no narcotics again as part of our ERAS protocol. So we don't use narcotics. And this just shows us for that 2017 to 2021 time period about 35% of laparoscopic cholecystectomy in the pediatric population for Niquip hospitals are going home the same day. Pediatric surgeons from around the globe discuss the safety and incidence of same day discharge for uncomplicated laparoscopic cholecystectomy. Nearly a third to half of surgeons are already sending their patients home on the same day. Setting expectations with the family prior to the procedure has helped with acceptance of same day discharges. And there are very few patients who come back within 24 hours of procedure. Don't forget to subscribe to the Stay current MD YouTube channel. Follow our social media channels and download the Stay current MD app for tons of content in pediatric surgery. Globalcast MD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.