Day case laparoscopic cholecystectomy: Identifying patients for a 'COVID-Cold' isolated day-case unit during the pandemic.

Background: The UK practice of laparoscopic cholecystectomy has reduced during the COVID-19 pandemic due to cancellation of non-urgent operations. Isolated day-case units have been recommended as 'COVID-cold' operating sites to resume surgical procedures. This study aims to identify patients suitable for day case laparoscopic cholecystectomy (DCLC) at isolated units by investigating patient factors and unexpected admission.
Method: Retrospective analysis of 327 patients undergoing DCLC between January and December 2018 at Ysbyty Gwynedd (District General Hospital; YG) and Llandudno General Hospital (isolated unit; LLGH), North Wales, UK.
Results: The results showed that 100% of DCLCs in LLGH were successful; 71.4% of elective DCLCs were successful at YG. Increasing age ( p  = 0.004), BMI ( p  = 0.01), ASA Score ( p  = 0.006), previous ERCP ( p  = 0.05), imaging suggesting cholecystitis ( p  = 0.003) and thick-walled gallbladder ( p  = 0.04) were significantly associated with failed DCLC on univariate analysis. Factors retaining significance (OR, 95% CI) after multiple regression include BMI (1.82, 1.05-3.16; p  = 0.034), imaging suggesting cholecystitis (4.42, 1.72-11.38; p  = 0.002) and previous ERCP (5.25, 1.53-18.00; p  = 0.008). Postoperative complications are comparable in BMI <35kg/m ² and 35-39.9kg/m ² .
Conclusions: Current patient selection for isolated day unit is effective in ensuring safe discharge and could be further developed with greater consideration for patients with BMI 35-39.9kg/m ² . As surgical services return, this helps identify patients suitable for laparoscopic cholecystectomy at isolated COVID-free day units.