A Prospective Cohort Analysis of the Prevalence and Predictive Factors of Delayed Discharge After Laparoscopic Cholecystectomy in Italy: The DeDiLaCo Study

Background: The concept of early discharge <= 24 hours after Laparoscopic Cholecystectomy (LC) is still doubted in Italy. This prospective multicentre study aims to analyze the prevalence of patients undergoing elective LC who experienced a delayed discharge > 24 hours in an extensive Italian national database and identify potential limiting factors of early discharge after LC. Methods: This is a prospective observational multicentre study performed from January 1, 2021 to December 31, 2021 by 90 Italian surgical units. Results: A total of 4664 patients were included in the study. Clinical reasons were found only for 850 patients (37.7%) discharged > 24 hours after LC. After excluding patients with nonclinical reasons for delayed discharge > 24 hours, 2 groups based on the length of hospitalization were created: the Early group (<= 24 h; 2414 patients, 73.9%) and the Delayed group (> 24 h; 850 patients, 26.1%). At the multivariate analysis, ASA III class (P < 0.0001), Charlson's Comorbidity Index (P = 0.001), history of choledocholithiasis (P = 0.03), presence of peritoneal adhesions (P < 0.0001), operative time > 60 min (P < 0.0001), drain placement (P < 0.0001), pain (P = 0.001), postoperative vomiting (P = 0.001) and complications (P < 0.0001) were independent predictors of delayed discharge > 24 hours. Conclusions: The majority of delayed discharges > 24 hours after LC in our study were unrelated to the surgery itself. ASA class > II, advanced comorbidity, the presence of peritoneal adhesions, prolonged operative time, and placement of abdominal drainage were intraoperative variables independently associated with failure of early discharge.