Analysis of risk factors for delayed discharge following same-day choledochoscopic lithotomy_West China Medical Journal

Authors：

LEI Tiantian ¹ , LIU Yang ¹ , SONG Yinghan ¹ ,  LIANG Peng ^1,2

1. Day Surgery Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Anesthesia Surgery Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LIANG Peng, Email: liangpengwch@scu.edu.cn

Keywords：

Choledochoscopy; hepatolithiasis; same-day surgery; risk factor

DOI：

10.7507/1002-0179.202401118

Video：

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Objective To investigate the risk factors for delayed discharge following same-day choledochoscopic lithotomy for residual stones after biliary tract surgery. Methods The clinical data of 607 patients with residual stone after biliary tract surgery admitted to the Day Surgery Center of West China Hospital of Sichuan University between July 2019 and July 2022 were retrospectively collected. According to whether the patients were discharged on the same day, they were divided into same-day discharge group and delayed discharge group. The differences in gender, age, first surgical procedure (surgical method, hepatectomy or not, intraoperative choledochoscopy or not), choledochoscopic lithotomy (first choledochoscopy or not, lithotomy method, number of stones and site of stones), operation duration, hospital stay, hospital cost, and postoperative complications (fever, poor drainage, and T tube dislodgement) between the two groups were compared and analyzed. Multiple logistic regression model was used to analyze the risk factors for delayed discharge following same-day choledochoscopic lithotomy. Results All patients were admitted and discharged within 24 h, among them, 557 cases (91.8%) were discharged on the same day and 50 cases (8.2%) were discharged the next day. The results of multiple logistic regression analysis showed that choledochoscopy for the first time [odds ratio (OR)=2.359, 95% confidence interval (CI) (1.303, 4.273), P=0.005], lithotomy after electrohydraulic lithotripsy [OR=1.857, 95%CI (1.013, 3.402), P=0.045], and multiple stones (number of stones ≥2) [OR=2.741, 95%CI (1.194, 6.288), P=0.017] were independent risk factors for delayed discharge. Conclusion The operation of same-day choledochoscopic lithotomy is mature, and choledochoscopy for the first time, lithotomy after electrohydraulic lithotripsy, and multiple stones (number of stones ≥2) are independent risk factors for delayed discharge.

Citation： LEI Tiantian, LIU Yang, SONG Yinghan, LIANG Peng. Analysis of risk factors for delayed discharge following same-day choledochoscopic lithotomy. West China Medical Journal, 2025, 40(2): 229-234. doi: 10.7507/1002-0179.202401118 Copy

1.	Lorio E, Patel P, Rosenkranz L, et al. Management of hepatolithiasis: review of the literature. Curr Gastroenterol Rep, 2020, 22(6): 30.
2.	張志鴻, 李炎陽, 李珂佳, 等. 開腹和腹腔鏡肝切除術治療復雜肝膽管結石的療效評價和策略分析. 臨床外科雜志, 2022, 30(6): 572-575.
3.	中國研究型醫院學會肝膽胰外科專業委員會, 國家衛生健康委員會公益性行業科研專項專家委員會. 肝膽管結石病微創手術治療指南(2019 版). 中華消化外科雜志, 2019, 18(5): 407-413.
4.	馮秋實. 內鏡技術治療肝膽管結石值得關注的幾個問題. 中國實用外科雜志, 2024, 44(3): 267-270.
5.	何彥安, 向鑫, 嚴超, 等. 肝膽管結石肝切除術后結石殘留的相關危險因素分析. 四川醫學, 2021, 42(6): 567-570.
6.	Li C, Wen T. Surgical management of hepatolithiasis: a minireview. Intractable Rare Dis Res, 2017, 6(2): 102-105.
7.	Jin RA, Wang Y, Yu H, et al. Total laparoscopic left hepatectomy for primary hepatolithiasis: eight-year experience in a single center. Surgery, 2016, 159(3): 834-841.
8.	Steiner CA, Karaca Z, Moore BJ, et al. Surgeries in hospital-based ambulatory surgery and hospital inpatient settings, 2014: statistical brief #223//Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US), 2020.
9.	Bailey CR, Ahuja M, Bartholomew K, et al. Guidelines for day-case surgery 2019: guidelines from the Association of Anaesthetists and the British Association of Day Surgery. Anaesthesia, 2019, 74(6): 778-792.
10.	Morales-García D, Docobo-Durantez F, Capitán Vallvey JM, et al. Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic. Cir Esp (Engl Ed), 2022, 100(3): 115-124.
11.	Pang G, Kwong M, Schlachta CM, et al. Safety of same-day discharge in high-risk patients undergoing ambulatory general surgery. J Surg Res, 2021, 263: 71-77.
12.	Dekonenko C, Svetanoff WJ, Osuchukwu OO, et al. Same-day discharge for pediatric laparoscopic gastrostomy. J Pediatr Surg, 2021, 56(1): 26-29.
13.	中國心胸血管麻醉學會日間手術麻醉分會, “基于術后加速康復的日歸手術全程管理專家共識”工作組. 基于術后加速康復的日歸手術全程管理專家共識. 中華麻醉學雜志, 2023, 43(4): 385-399.
14.	雷甜甜, 梁鵬, 馬洪升, 等. 四川大學華西醫院日歸手術管理實踐. 廣東醫學, 2022, 43(10): 1222-1228.
15.	呂子寧, 劉洋, 梁鵬. 個體化的加速康復外科理念在日歸手術麻醉中的應用. 華西醫學, 2022, 37(2): 262-266.
16.	詹麗莉, 劉洋, 蔣麗莎, 等. 日歸模式在日間手術的臨床應用與探討. 華西醫學, 2022, 37(2): 189-193.
17.	Motta RV, Saffioti F, Mavroeidis VK. Hepatolithiasis: epidemiology, presentation, classification and management of a complex disease. World J Gastroenterol, 2024, 30(13): 1836-1850.
18.	Liepert AE, Ancheta M, Williamson E. Management of gallstone disease. Surg Clin North Am, 2024, 104(6): 1159-1173.
19.	Dilek ON, Atasever A, Acar N, et al. Hepatolithiasis: clinical series, review and current management strategy. Turk J Surg, 2020, 36(4): 382-392.
20.	Aloreidi K, Sethi P, Yeager T, et al. Percutaneous endoscopic management for oriental cholangiohepatitis: a case report and a brief review of the literature. Case Rep Gastrointest Med, 2017, 2017: 8575674.
21.	Uchiyama K, Kawai M, Tani M, et al. Pathogenesis of hepatolithiasis based on the analysis of components of intrahepatic stones. Hepatogastroenterology, 2007, 54(78): 1798-1804.
22.	陳宇泰, 曾昕, 譚澳宇, 等. 腹腔鏡技術聯合膽道鏡治療復雜肝膽管結石的臨床觀察. 肝膽外科雜志, 2024, 32(4): 259-263.
23.	肖有田, 米棋, 丁久洪, 等. 腹腔鏡左半肝切除術聯合膽道鏡取石術治療復雜肝內膽管結石臨床觀察. 山東醫藥, 2022, 62(25): 77-79.
24.	趙剛, 劉洋, 張洪義, 等. 膽道鏡治療肝膽管殘余結石 36 例臨床分析. 海南醫學, 2015, 26(11): 1673-1674.
25.	Cheon YK, Cho YD, Moon JH, et al. Evaluation of long-term results and recurrent factors after operative and nonoperative treatment for hepatolithiasis. Surgery, 2009, 146(5): 843-853.
26.	Yu ZY, Sun ZQ, Zhang M, et al. Hepatolithiasis associated with intrahepatic heterotopic pancreas: a case report and literature review. Diagn Pathol, 2015, 10: 76.
27.	彭鵬, 劉修元, 楊林. 膽道結石術后經 T 管竇道膽道鏡聯合液電碎石術治療殘留結石的效果分析. 系統醫學, 2024, 9(8): 145-147, 158.
28.	Tezuka R, Okuno M, Mukai T, et al. Electrohydraulic lithotripsy under the mother-baby cholangioscope system using a colonoscope for large common bile duct stones in a patient with Roux-en-Y reconstruction. VideoGIE, 2021, 6(8): 358-361.
29.	Lamanna A, Maingard J, Bates D, et al. Percutaneous transhepatic laser lithotripsy for intrahepatic cholelithiasis: a technical report. J Med Imaging Radiat Oncol, 2019, 63(6): 758-764.
30.	Bukhari M, Chen YI, Gutierrez OB, et al. Direct per-oral cholangioscopy with electrohydraulic lithotripsy for primary severe hepatolithiasis. VideoGIE, 2017, 2(9): 241-243.
31.	Liu R, Zhang B, Liu D. Peroral cholangioscopy-guided laser lithotripsy to treat regional hepatolithiasis without stricture. Dig Endosc, 2018, 30(4): 537-538.
32.	王星入, 李曉舉, 萬丹丹, 等. 肝膽管結石病診療的焦點與爭議. 中華消化外科雜志, 2024, 23(4): 579-589.
33.	陳靜, 歐靜, 周海鷹, 等. 肝內膽管結石及其并發癥的磁共振成像研究. 川北醫學院學報, 2022, 37(7): 839-842.

1. Lorio E, Patel P, Rosenkranz L, et al. Management of hepatolithiasis: review of the literature. Curr Gastroenterol Rep, 2020, 22(6): 30.
2. 張志鴻, 李炎陽, 李珂佳, 等. 開腹和腹腔鏡肝切除術治療復雜肝膽管結石的療效評價和策略分析. 臨床外科雜志, 2022, 30(6): 572-575.
3. 中國研究型醫院學會肝膽胰外科專業委員會, 國家衛生健康委員會公益性行業科研專項專家委員會. 肝膽管結石病微創手術治療指南(2019 版). 中華消化外科雜志, 2019, 18(5): 407-413.
4. 馮秋實. 內鏡技術治療肝膽管結石值得關注的幾個問題. 中國實用外科雜志, 2024, 44(3): 267-270.
5. 何彥安, 向鑫, 嚴超, 等. 肝膽管結石肝切除術后結石殘留的相關危險因素分析. 四川醫學, 2021, 42(6): 567-570.
6. Li C, Wen T. Surgical management of hepatolithiasis: a minireview. Intractable Rare Dis Res, 2017, 6(2): 102-105.
7. Jin RA, Wang Y, Yu H, et al. Total laparoscopic left hepatectomy for primary hepatolithiasis: eight-year experience in a single center. Surgery, 2016, 159(3): 834-841.
8. Steiner CA, Karaca Z, Moore BJ, et al. Surgeries in hospital-based ambulatory surgery and hospital inpatient settings, 2014: statistical brief #223//Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US), 2020.
9. Bailey CR, Ahuja M, Bartholomew K, et al. Guidelines for day-case surgery 2019: guidelines from the Association of Anaesthetists and the British Association of Day Surgery. Anaesthesia, 2019, 74(6): 778-792.
10. Morales-García D, Docobo-Durantez F, Capitán Vallvey JM, et al. Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic. Cir Esp (Engl Ed), 2022, 100(3): 115-124.
11. Pang G, Kwong M, Schlachta CM, et al. Safety of same-day discharge in high-risk patients undergoing ambulatory general surgery. J Surg Res, 2021, 263: 71-77.
12. Dekonenko C, Svetanoff WJ, Osuchukwu OO, et al. Same-day discharge for pediatric laparoscopic gastrostomy. J Pediatr Surg, 2021, 56(1): 26-29.
13. 中國心胸血管麻醉學會日間手術麻醉分會, “基于術后加速康復的日歸手術全程管理專家共識”工作組. 基于術后加速康復的日歸手術全程管理專家共識. 中華麻醉學雜志, 2023, 43(4): 385-399.
14. 雷甜甜, 梁鵬, 馬洪升, 等. 四川大學華西醫院日歸手術管理實踐. 廣東醫學, 2022, 43(10): 1222-1228.
15. 呂子寧, 劉洋, 梁鵬. 個體化的加速康復外科理念在日歸手術麻醉中的應用. 華西醫學, 2022, 37(2): 262-266.
16. 詹麗莉, 劉洋, 蔣麗莎, 等. 日歸模式在日間手術的臨床應用與探討. 華西醫學, 2022, 37(2): 189-193.
17. Motta RV, Saffioti F, Mavroeidis VK. Hepatolithiasis: epidemiology, presentation, classification and management of a complex disease. World J Gastroenterol, 2024, 30(13): 1836-1850.
18. Liepert AE, Ancheta M, Williamson E. Management of gallstone disease. Surg Clin North Am, 2024, 104(6): 1159-1173.
19. Dilek ON, Atasever A, Acar N, et al. Hepatolithiasis: clinical series, review and current management strategy. Turk J Surg, 2020, 36(4): 382-392.
20. Aloreidi K, Sethi P, Yeager T, et al. Percutaneous endoscopic management for oriental cholangiohepatitis: a case report and a brief review of the literature. Case Rep Gastrointest Med, 2017, 2017: 8575674.
21. Uchiyama K, Kawai M, Tani M, et al. Pathogenesis of hepatolithiasis based on the analysis of components of intrahepatic stones. Hepatogastroenterology, 2007, 54(78): 1798-1804.
22. 陳宇泰, 曾昕, 譚澳宇, 等. 腹腔鏡技術聯合膽道鏡治療復雜肝膽管結石的臨床觀察. 肝膽外科雜志, 2024, 32(4): 259-263.
23. 肖有田, 米棋, 丁久洪, 等. 腹腔鏡左半肝切除術聯合膽道鏡取石術治療復雜肝內膽管結石臨床觀察. 山東醫藥, 2022, 62(25): 77-79.
24. 趙剛, 劉洋, 張洪義, 等. 膽道鏡治療肝膽管殘余結石 36 例臨床分析. 海南醫學, 2015, 26(11): 1673-1674.
25. Cheon YK, Cho YD, Moon JH, et al. Evaluation of long-term results and recurrent factors after operative and nonoperative treatment for hepatolithiasis. Surgery, 2009, 146(5): 843-853.
26. Yu ZY, Sun ZQ, Zhang M, et al. Hepatolithiasis associated with intrahepatic heterotopic pancreas: a case report and literature review. Diagn Pathol, 2015, 10: 76.
27. 彭鵬, 劉修元, 楊林. 膽道結石術后經 T 管竇道膽道鏡聯合液電碎石術治療殘留結石的效果分析. 系統醫學, 2024, 9(8): 145-147, 158.
28. Tezuka R, Okuno M, Mukai T, et al. Electrohydraulic lithotripsy under the mother-baby cholangioscope system using a colonoscope for large common bile duct stones in a patient with Roux-en-Y reconstruction. VideoGIE, 2021, 6(8): 358-361.
29. Lamanna A, Maingard J, Bates D, et al. Percutaneous transhepatic laser lithotripsy for intrahepatic cholelithiasis: a technical report. J Med Imaging Radiat Oncol, 2019, 63(6): 758-764.
30. Bukhari M, Chen YI, Gutierrez OB, et al. Direct per-oral cholangioscopy with electrohydraulic lithotripsy for primary severe hepatolithiasis. VideoGIE, 2017, 2(9): 241-243.
31. Liu R, Zhang B, Liu D. Peroral cholangioscopy-guided laser lithotripsy to treat regional hepatolithiasis without stricture. Dig Endosc, 2018, 30(4): 537-538.
32. 王星入, 李曉舉, 萬丹丹, 等. 肝膽管結石病診療的焦點與爭議. 中華消化外科雜志, 2024, 23(4): 579-589.
33. 陳靜, 歐靜, 周海鷹, 等. 肝內膽管結石及其并發癥的磁共振成像研究. 川北醫學院學報, 2022, 37(7): 839-842.

West China Medical Journal

Analysis of risk factors for delayed discharge following same-day choledochoscopic lithotomy

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