Anahita D Jalilvand, MD, Patricia Belle, Monet Mcnally, Kyle A Perry, MD. The Ohio State Wexner Medical Center
INTRODUCTION: A significant proportion of early readmissions following elective surgery have been characterized as non-urgent and potentially avoidable with appropriate patient education and post-operative follow-up. The goal of this study was to characterize early readmissions after laparoscopic paraesophageal hernia repair (LPEHR) and Nissen Fundoplication (LNF) and determine independent predictors for non-urgent readmissions.
METHODS: Patients who underwent elective LPEHR and LNF at a single academic institution from 2011 to 2017 were retrospectively reviewed (n=562). Redo and emergent operations were excluded. Baseline medical, demographic and operative data, and post-operative complications were documented. Readmissions within 90 days of discharge were categorized by whether they were surgery-related and if they required urgent intervention. Readmissions requiring symptom control and intravenous fluid resuscitation only (pain, nausea/vomiting, dysphagia) were deemed non-urgent readmissions (NUR). Variables associated with NUR were determined through univariate analyses, and multiple logistic regressions were completed to identify independent patient-level predictors of NUR. A p value <0.05 was considered statistically significant.
RESULTS: Sixty-eight patients (12.1%) were readmitted within 90 days of discharge; and 56 (9.9%) were surgery related. Thirty-nine patients (6.9%) were readmitted and classified as surgery-related NUR. On univariate analysis, patients in the NUR group had significantly lower body mass index (BMI) (28.4 ± 5.9 kg/m2vs 31.4 ± 5.4 kg/m2, p<0.01) and were less likely to be Caucasian (74.4% vs 90.7%, p<0.01) compared to non-readmitted patients. While there was no association with age (p=0.37), insurance status (p=0.39), or ASA score (p=0.39), a baseline diagnosis of depression was significantly associated with NUR (41.0% vs 25.9%, p=0.04). NUR patients also had significantly higher baseline Gastroesophageal Reflux Symptom Scale (GERSS) scores (45.5 (28-60) vs 35 (19-48), p=0.02), and trended towards decreased lower esophageal sphincter pressure (LESP) (10.6 (3.3-18) vs 15.2 (7.8-25), p=0.09) and higher rates of dysphagia post-operatively (10.3% vs 4.5%, p=0.11). Length of stay, surgery type, operative time, and other post-operative complications were not associated with NUR. After adjusting for LESP, depression, race, and post-operative dysphagia, independent predictors of NUR included decreasing BMI (OR 0.92, p=0.04) and having a GERSS score in the top quartile (OR 5.8, p=0.03).
CONCLUSIONS: In this study, the majority of surgery related readmissions following elective LPEHR and LNF were non-urgent and potentially preventable. Baseline symptom severity and increased post-operative dysphagia may indicate increased risk of NUR, and represent opportunities for early post-operative education and outpatient intervention to reduce unnecessary readmissions after elective foregut surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95166
Program Number: S063
Presentation Session: Residents and Fellows Session
Presentation Type: ResFel