Thirty-day clinical outcomes, early recovery, and healthcare resource use after planned ambulatory vs. conventional inpatient laparoscopic cholecystectomy: a propensity-score overlap-weighted retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Real-world comparisons of planned ambulatory and conventional inpatient laparoscopic cholecystectomy are vulnerable to patient selection and organisational differences. We used propensity score overlap weighting to compare 30-day safety, early recovery, and recorded healthcare resource use between the two planned pathways. Methods This single-centre retrospective cohort included 223 adults who underwent elective laparoscopic cholecystectomy for benign gallstone-related disease at Shanxi Bethune Hospital between May 2025 and June 2026. Patients were classified by their preoperative plan as ambulatory (defined as arrival on the day of surgery and intended discharge within 24 h) or conventional inpatient care. The primary outcome was a 30-day adverse clinical composite comprising Clavien–Dindo grade ≥2 complications, unplanned emergency department visits, readmission, endoscopic retrograde cholangiopancreatography or another intervention, reoperation, or death. Overlap weights balanced preoperative characteristics, and 1:1 propensity score matching served as a sensitivity analysis. Results The ambulatory and inpatient groups included 78 and 145 patients, respectively. All included covariates demonstrated absolute standardised mean differences below 0.10 after overlap weighting. Weighted risks of the 30-day composite were 3.8% and 10.2%, giving a risk ratio of 0.37 (95% confidence interval, 0.02 to 1.25) and a risk difference of −6.4 percentage points (−13.8 to 1.4; P = 0.100). The ambulatory pathway was associated with 70.3 fewer postoperative hours and 100.0 fewer total hospital hours. Ambulation and oral intake occurred 5.7 and 6.9 h earlier, discharge pain was 1.13 points lower, and recorded index-admission hospital charges were CNY 5,200 lower; all P < 0.001. Seven ambulatory patients (9.0%) had pathway failure. Results from 59 matched pairs were directionally consistent. Conclusions Among patients with a realistic possibility of receiving either pathway, planned ambulatory care was not associated with an increase in the 30-day adverse clinical composite and was associated with shorter hospital stay and lower recorded healthcare resource utilisation. However, important determinants of pathway selection were incompletely measured. The single-centre observational design, residual confounding, and small number of primary events preclude causal interpretation or claims of safety equivalence.
Source: Frontiers in Surgery
Institutions: Shanxi Medical University, Shanxi Academy of Medical Sciences
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7222733789