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.	张志鸿, 李炎阳, 李珂佳, 等. 开腹和腹腔镜肝切除术治疗复杂肝胆管结石的疗效评价和策略分析. 临床外科杂志, 2022, 30(6): 572-575.
3.	中国研究型医院学会肝胆胰外科专业委员会, 国家卫生健康委员会公益性行业科研专项专家委员会. 肝胆管结石病微创手术治疗指南(2019 版). 中华消化外科杂志, 2019, 18(5): 407-413.
4.	冯秋实. 内镜技术治疗肝胆管结石值得关注的几个问题. 中国实用外科杂志, 2024, 44(3): 267-270.
5.	何彦安, 向鑫, 严超, 等. 肝胆管结石肝切除术后结石残留的相关危险因素分析. 四川医学, 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.	中国心胸血管麻醉学会日间手术麻醉分会, “基于术后加速康复的日归手术全程管理专家共识”工作组. 基于术后加速康复的日归手术全程管理专家共识. 中华麻醉学杂志, 2023, 43(4): 385-399.
14.	雷甜甜, 梁鹏, 马洪升, 等. 四川大学华西医院日归手术管理实践. 广东医学, 2022, 43(10): 1222-1228.
15.	吕子宁, 刘洋, 梁鹏. 个体化的加速康复外科理念在日归手术麻醉中的应用. 华西医学, 2022, 37(2): 262-266.
16.	詹丽莉, 刘洋, 蒋丽莎, 等. 日归模式在日间手术的临床应用与探讨. 华西医学, 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.	陈宇泰, 曾昕, 谭澳宇, 等. 腹腔镜技术联合胆道镜治疗复杂肝胆管结石的临床观察. 肝胆外科杂志, 2024, 32(4): 259-263.
23.	肖有田, 米棋, 丁久洪, 等. 腹腔镜左半肝切除术联合胆道镜取石术治疗复杂肝内胆管结石临床观察. 山东医药, 2022, 62(25): 77-79.
24.	赵刚, 刘洋, 张洪义, 等. 胆道镜治疗肝胆管残余结石 36 例临床分析. 海南医学, 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.	彭鹏, 刘修元, 杨林. 胆道结石术后经 T 管窦道胆道镜联合液电碎石术治疗残留结石的效果分析. 系统医学, 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, 李晓举, 万丹丹, 等. 肝胆管结石病诊疗的焦点与争议. 中华消化外科杂志, 2024, 23(4): 579-589.
33.	陈静, 欧静, 周海鹰, 等. 肝内胆管结石及其并发症的磁共振成像研究. 川北医学院学报, 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. 张志鸿, 李炎阳, 李珂佳, 等. 开腹和腹腔镜肝切除术治疗复杂肝胆管结石的疗效评价和策略分析. 临床外科杂志, 2022, 30(6): 572-575.
3. 中国研究型医院学会肝胆胰外科专业委员会, 国家卫生健康委员会公益性行业科研专项专家委员会. 肝胆管结石病微创手术治疗指南(2019 版). 中华消化外科杂志, 2019, 18(5): 407-413.
4. 冯秋实. 内镜技术治疗肝胆管结石值得关注的几个问题. 中国实用外科杂志, 2024, 44(3): 267-270.
5. 何彦安, 向鑫, 严超, 等. 肝胆管结石肝切除术后结石残留的相关危险因素分析. 四川医学, 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. 中国心胸血管麻醉学会日间手术麻醉分会, “基于术后加速康复的日归手术全程管理专家共识”工作组. 基于术后加速康复的日归手术全程管理专家共识. 中华麻醉学杂志, 2023, 43(4): 385-399.
14. 雷甜甜, 梁鹏, 马洪升, 等. 四川大学华西医院日归手术管理实践. 广东医学, 2022, 43(10): 1222-1228.
15. 吕子宁, 刘洋, 梁鹏. 个体化的加速康复外科理念在日归手术麻醉中的应用. 华西医学, 2022, 37(2): 262-266.
16. 詹丽莉, 刘洋, 蒋丽莎, 等. 日归模式在日间手术的临床应用与探讨. 华西医学, 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. 陈宇泰, 曾昕, 谭澳宇, 等. 腹腔镜技术联合胆道镜治疗复杂肝胆管结石的临床观察. 肝胆外科杂志, 2024, 32(4): 259-263.
23. 肖有田, 米棋, 丁久洪, 等. 腹腔镜左半肝切除术联合胆道镜取石术治疗复杂肝内胆管结石临床观察. 山东医药, 2022, 62(25): 77-79.
24. 赵刚, 刘洋, 张洪义, 等. 胆道镜治疗肝胆管残余结石 36 例临床分析. 海南医学, 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. 彭鹏, 刘修元, 杨林. 胆道结石术后经 T 管窦道胆道镜联合液电碎石术治疗残留结石的效果分析. 系统医学, 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, 李晓举, 万丹丹, 等. 肝胆管结石病诊疗的焦点与争议. 中华消化外科杂志, 2024, 23(4): 579-589.
33. 陈静, 欧静, 周海鹰, 等. 肝内胆管结石及其并发症的磁共振成像研究. 川北医学院学报, 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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