Date of Award

9-2025

Degree Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Advisor

Prof. Abdallah Abdulkarim

Second Advisor

Prof. Asad Jamil Raja

Department

General Surgery (East Africa)

Abstract

Background: While daycare laparoscopic cholecystectomy is gaining momentum in developed countries, a majority of patients in low and middle-income countries are admitted overnight. This safety precaution offers prompt access to emergency services should need arise. This precautional overnight stay has implications on cost, healthcare utilization and patient satisfaction. Daycare procedures routinely utilize scoring systems for assessing discharge readiness. We explored the utility of the modified Surgical APGAR Score (mSAS) and the White Fast Track Score (WFTS) as predictors for postoperative events and their role in identifying patients who can have a safe daycare discharge after laparoscopic cholecystectomy in this retrospective cohort study.

Primary Objective: To assess if the mSAS and WFTS can reasonably predict the occurrence of postoperative events and identify patients eligible for safe daycare laparoscopic cholecystectomy at the Aga Khan University Hospital, Nairobi.

Methodology: A total of 139 elective laparoscopic cholecystectomy cases were retrospectively studied. Collected data included demographics, perioperative characteristics, postoperative events and length of hospital stay as well as reasons for and frequency of post discharge hospital visits. The occurrence of postoperative events and prediction of postoperative length of stay were assessed by univariate analysis and multivariable regression, respectively.

Results: During inpatient stay, postoperative breakthrough pain occurred in 35% of patients while nausea and vomiting occurred in 18% and 6.5% of the patients respectively. The need for rescue analgesia and antiemetic was low at 1.4% and 5.8% apiece. Only three (2.2%) cases of unplanned hospital visits within 24 hours were for a procedure related 2

concern; postoperative pain. Most of the cases (103 cases, 74.1%) were performed in the afternoon. Five (3.6%), seventy-one (51.1%) and sixty-three (45.3%) patients were discharged on the day of the surgery, within 24 hours and after 24 hours respectively. Sixty patients (43.2%) experienced either PONV, postoperative pain or both, while the remainder (79 patients, 56.8%) reported no nausea, vomiting nor breakthrough pain and were eventually discharged without concerns. The mSAS and WFTS did not demonstrate significant associations and were therefore not reliable independent predictors of the occurrence of postoperative events nor the length of stay.

Conclusion: While postoperative bleeding is rare, breakthrough postoperative pain and PONV are not uncommon after laparoscopic cholecystectomy in our setting. Nonetheless, only a small minority experience severe breakthrough pain or PONV, requiring rescue measures or extension of stay. More than half of our study population had an uneventful postoperative period and may be suitable for daycare discharge. The postoperative scores, mSAS and the WFTS, are poor predictors for postoperative events and are therefore not reliable criteria for use in a daycare discharge alone.

First Page

1

Last Page

58

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