{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T18:08:05Z","timestamp":1780078085834,"version":"3.54.0"},"reference-count":21,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: In standardized low-event surgery such as laparoscopic cholecystectomy (LC), discharge-based outcomes may be insufficiently sensitive to capture differences in recovery trajectory. We investigated whether early gastrointestinal recovery after standardized LC differed according to anesthetic maintenance strategy. Methods: This single-center retrospective cohort study included consecutive adults who underwent scheduled LC between September 2023 and December 2025 within a standardized perioperative pathway. The primary exposure was anesthetic maintenance strategy, comparing remimazolam-based with desflurane-based maintenance. The primary outcome was time to first flatus. Key secondary outcomes included postoperative day 1 (POD 1) high-sensitivity C-reactive protein (hs-CRP), C-reactive protein-to-albumin ratio (CAR), diet delay, prolonged hospital stay, postoperative nausea and vomiting, and 30-day readmission. Associations were evaluated using a log-normal accelerated failure time model, multivariable logistic regression, and log-transformed linear models for inflammatory markers. Results: A total of 316 patients were included (remimazolam, n = 171; desflurane, n = 145). Time to first flatus was shorter in the remimazolam group, with an unadjusted median difference of 8 h (28.0 [24.0\u201337.0] vs. 36.0 [28.0\u201352.0] h). After adjustment, remimazolam-based maintenance remained associated with a 21% shorter time to first flatus (time ratio, 0.79; 95% confidence interval [CI], 0.72\u20130.86; p &lt; 0.001), corresponding to an adjusted median reduction of 8.0 h. The remimazolam group also showed earlier flatus recovery across predefined time windows and lower POD 1 hs-CRP and CAR, whereas later outcomes were largely similar. Conclusions: In standardized LC, early gastrointestinal recovery appeared more sensitive to anesthetic maintenance strategy than discharge-based outcomes. These findings support the use of early functional recovery measures, in addition to discharge timing, when evaluating perioperative recovery in low-event short-stay surgery.<\/jats:p>","DOI":"10.3390\/jcm15114202","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T17:36:18Z","timestamp":1780076178000},"page":"4202","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Remimazolam-Based Versus Desflurane-Based Maintenance with Early Gastrointestinal Recovery After Laparoscopic Cholecystectomy: A Single-Center Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7764-9516","authenticated-orcid":false,"given":"Byeong Gwan","family":"Noh","sequence":"first","affiliation":[{"name":"Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea"},{"name":"Department of Surgery, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7967-1127","authenticated-orcid":false,"given":"Eun Ji","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea"},{"name":"Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9271-7241","authenticated-orcid":false,"given":"Myunghee","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea"},{"name":"Department of Surgery, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4132-7662","authenticated-orcid":false,"given":"Hyung Il","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea"},{"name":"Department of Surgery, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Mok","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea"},{"name":"Department of Surgery, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myeong Hun","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea"},{"name":"Department of Surgery, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3450-865X","authenticated-orcid":false,"given":"Hyeon-Jeong","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea"},{"name":"Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong-Min","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea"},{"name":"Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boo-young","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea"},{"name":"Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Unji","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingyu","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"ref_1","first-page":"148","article-title":"The Treatment of Gallstone Disease","volume":"117","author":"Gutt","year":"2020","journal-title":"Dtsch. 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