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AMBULATORY ANESTHESIA

Patient Preferences for Early Discharge After Laparoscopic Cholecystectomy

Harold P. Lehmann, MD, PhD^*, Lee A. Fleisher, MD^,,§, Janet Lam, AB, Barbara A. Frink, RN, PhD^||, and Eric B. Bass, MD^,§

Departments of *Pediatrics, Anesthesiology and Critical Care Medicine, Medicine, and §Health Policy and Management and Division of Biomedical Information Sciences, ||Schools of Medicine and Nursing, Johns Hopkins School of Medicine, Baltimore, Maryland

Address correspondence and reprint requests to Lee A. Fleisher, MD, The Johns Hopkins Hospital, 600 North Wolfe St., Carnegie 280, Baltimore, MD 21287. Address e-mail to lfleishe{at}welchlink.welch.jhu.edu

Patients may have concerns about their ability to manage postoperative symptoms at home after ambulatory surgery. We assessed patients' attitudes toward postoperative care at home or in the hospital after laparoscopic cholecystectomy. Thirty-eight patients undergoing elective laparoscopic cholecystectomy were pre- and postoperatively (within a week each) presented with scenarios describing symptoms of differing severity in either a home or hospital setting and were asked to rank and rate the relative desirability of the scenarios using rating scale, standard gamble, and willingness-to-pay techniques. Preoperatively, 16 (42%), 21 (55%), and 30 (79%) patients ranked pain of mild, moderate, and severe levels, respectively, as worse than the respective levels of nausea and vomiting. Of 24 patients, 19 (79%) preferred home care to hospital care for mild symptoms, and 12 of 22 patients (55%) preferred home care to hospital care for moderate symptoms. The average ratings were 20, 53, and 90 for mild, moderate, and severe symptoms, respectively, where 0 = no symptoms and 100 = the worst symptoms possible. Patients who preferred care outside the home indicated that they were willing to pay a mean of $142 (maximum $410) as a maximal copayment to have postoperative care in the hospital and a mean of $255 to receive care in a medical hotel-like facility. Postoperative assessment correlated highly with the preoperative assessment (correlation coefficient >0.6 for rating, standard gamble, and willingness-to-pay assessments). We conclude that patients vary in their attitudes toward where they would like to receive postoperative care. Attitudes assessed preoperatively may predict their attitudes postoperatively.

Implications: Patients preferred to be at home for mild postoperative symptoms but in the hospital for worse postoperative symptoms. Preferences did not change with different methods of asking and were the same pre- and postoperatively. If patients made choices for their care before their procedure, they would still be happy with those decisions postoperatively.

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