Diagnosis: Abdominal Pain
Treatment: Inpatient admission
The proposed inpatient treatment was not medically necessary.

After an uncomplicated elective laparoscopic cholecystectomy, patients can drink clear liquids once awake from anesthesia, and their diet can be advanced as tolerated.

Most otherwise healthy, reliable patients with good home support can leave the hospital within six hours after surgery. Cochrane reviews have found no significant differences for important clinical outcomes for patients discharged the same day versus admitted overnight following laparoscopic cholecystectomy. A retrospective review of the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) database, which included 15,248 patients older than 65 years of age who underwent elective laparoscopic cholecystectomy, identified congestive heart failure, American Society of Anesthesiologists class IV, bleeding disorder, and renal failure requiring dialysis as significant independent predictors of inpatient admission and mortality.

This patient presented with signs and symptoms of acute cholecystitis with confirmatory diagnostic imaging. There were no signs and symptoms of sepsis and no untoward events during or after surgery. All available laboratory data was trending downward after the infected organ was removed. Therefore, the inpatient admission was not medically necessary.