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
- 1Department of Hepatobiliary Surgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital , ,
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.
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BibTeX
@article{hao2026thirtyday,
title = {{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}},
author = {Yi Hao and Yi Wang and Qinyang Du and Rongshen Guan and Qirui Zhang and Gaopeng Li},
journal = {Frontiers in surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1962424},
url = {https://europepmc.org/article/PMC/PMC13719444},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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
AU - Yi Hao
AU - Yi Wang
AU - Qinyang Du
AU - Rongshen Guan
AU - Qirui Zhang
AU - Gaopeng Li
PY - 2026
DA - 2026/10/16
JO - Frontiers in surgery
DO - 10.3389/fsurg.2026.1962424
UR - https://europepmc.org/article/PMC/PMC13719444
AB - 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.
SN - 2296-875X
ER -