Tarik K Yuce, MD1, Ryan J Ellis, MD, MS1, Ryan P Merkow, MD, MS1, Nathaniel J Soper, MD2, Karl Y Bilimoria, MD, MS1, David D Odell, MD, MS1. 1Surgical Outcomes and Quality Improvement Center, 2Department of Surgery, Northwestern Memorial Hospital
Introduction: Traditionally, laparoscopic Nissen fundoplication (LNF) was associated with inpatient hospitalization. More recently, insurers and health systems have pushed for same day discharge. However, surgical outcomes in these patients are poorly understood. We describe the frequency of complications and readmission after same day discharge following elective Nissen fundoplication.
Methods and Procedures: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify all elective LNF from 2012 to 2016. Patients discharged on the day of surgery were compared to those discharged on postoperative day (POD) 1 or 2. Outcomes studied included 30-day readmission and death or serious morbidity (DSM). Associations between same day discharge and both DSM and 30-day readmission were assessed using multivariable logistic regression. Readmission was further analyzed using Kaplan-Meier failure estimates and log-rank tests for equality.
Results: Of 7,734 patients who underwent elective LNF, 568 (7.3%) were discharged on the day of surgery. Patients were less likely to be discharged on the day of surgery if they had an ASA class >III (26.8% vs 36.6%, p<0.001), preoperative history of COPD (2.3% vs 4.6%, p=0.011), preoperative steroid use (2.1% vs 4.8%, p=0.004), or dyspnea (4.9% vs 9.0%, p=0.001). On multivariable analysis, there was no association between day of discharges and DSM (OR 0.91, 95% CI 0.36-2.29) or 30-day readmission (OR 0.97, 95% CI 0.62-1.52). While patients discharged on the day of surgery had higher unadjusted rates of early readmission, Kaplan-Meier analysis showed no difference in rates of hospital readmission between groups at 30-days from discharge (3.9% v 4.1%, p=0.325, Figure 1). The most common 30-day readmission diagnoses overall were nausea/vomiting (11.5%), dysphagia (11.1%), and abdominal pain (5.7%).
Conclusions: Same day discharge of patients following Nissen fundoplication was not associated with an increase in perioperative complications or 30-day readmission. However, an increase in early readmission following same day discharge may be present. Furthermore, interventions focused on improvement of postoperative abdominal pain along with prevention of nausea and vomiting may provide an opportunity to improve readmission rates. Future work focused on identifying patients least likely to have early readmission after same day discharge is warranted.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95088
Program Number: P458
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster