Research Article ‘True Day Case’ Laparoscopic Cholecystectomy in a High-Volume Specialist Unit and Review of Factors Contributing to Unexpected Overnight Stay A. Solodkyy , A. R. Hakeem, N. Oswald, F. Di Franco, S. Gergely, and A. M. Harris Department of Upper Gastrointestinal Surgery, Hinchingbrooke Hospital, Hinchingbrooke Park, Huntingdon, Cambridgeshire PE29 6NT, UK Correspondence should be addressed to A. M. Harris; adrianharris@nhs.net Received 23 January 2018; Accepted 14 June 2018; Published 24 July 2018 Academic Editor: Peng Hui Wang Copyright © 2018 A. Solodkyy et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Laparoscopic cholecystectomy (LC) is the gold standard treatment for gallstones. British Association of Day Case Surgery recommends at least 60% of LCs be performed as day cases. e aim of this study was to assess our rate of true day case LCs and review factors preventing same-day discharge. Methods. We prospectively collected data of all elective LCs performed in a district general hospital over 32 months. Results. 500 patients underwent LC during this period; 438 (88.2%) patients were planned day cases and 59 patients (11.8%) planned overnight stays. Of the planned day cases, 75.8% (n=332) were discharged on the same day and 106 (24.2%) had unexpected overnight stay (UOS). Most patients with BMI >35 and ASA3 planned day case patients were successfully discharged. Drain insertion, longer operations, and late recovery departure were the main reasons for UOS. ere were more complications in this group compared to day cases. Conclusions. is unit has a high ‘true day case’ rate of 75.8%. High BMI and ASA3 should not be absolute contraindications to day case surgery. e majority of unexpected overnight stays are unavoidable but may be reduced by patient selection, stringent preoperative assessment, operation scheduling, and reduction in unnecessary drain insertion. 1. Introduction Laparoscopic cholecystectomy (LC) is the gold standard of the treatment for gallstones [1]. Increasing the number of elective LCs performed as day case (at least 75%) is a key target in the National Health Service (NHS) plan issued by the UK Department of Health [2]. British Association of Day Surgery (BADS) recommends that at least 60% of LC operations should be performed as day cases both for optimal patient outcomes and cost-effectiveness [3]. Although a number of studies have reported that day case LC is feasible, effective, and safe, the national average for successful day case LC is reported to be only around 16% [3–6]. is may be in part due to use of so-called ‘absolute criteria’ guiding admission policies in many units. ere is still ambiguity in the way the day case LC data is presented in the literature, with considerable confusion between the so-called ‘23-hour’ stay and true day cases where the patient is discharged on the same day of surgery [7, 8]. e definition of ‘true day case’ procedure as per BADS guidelines is as follows: a patient is admitted, has a procedure performed, requires recovery facilities, and is discharged on the same day and does not stay overnight in the hospital [3]. However, some units ‘reinterpret’ the definition and hence report those patients who stayed overnight and get discharged the following morning as ‘day cases’, based on the 23-hour stay guideline [7]. Unexpected admission following day case procedure is an unwanted outcome for the patient, the surgeon, and the trust [9, 10]. Overnight stay leads to inconvenience among the patients and carers and can lead to poor patient experience and satisfaction [11]. Admission of these patients increases the pressure on acute hospital beds and has significant economic implications. A high unexpected admission rate invariably reflects on the suboptimal efficiency of the trust and is considered as a failure of day care facilities [12, 13]. Hindawi Minimally Invasive Surgery Volume 2018, Article ID 1260358, 8 pages https://doi.org/10.1155/2018/1260358