Laura Leonard, MD1, Turner Osler, MD2, Conor O’Neill2, Edward Borrazzo, MD2. 1University of Colorado School of Medicine, 2University of Vermont Larner College of Medicine
OBJECTIVE: This study aimed to identify factors predictive of successful day-case laparoscopic antireflux surgery (LARS) and to develop a model which would allow clinicians to preoperatively predict which patients could safely undergo LARS as an outpatient.
METHODS: Retrospective chart review of adult patients who underwent elective LARS at UVMMC from 2005 to 2014 was conducted. Patients were divided into those requiring at least one night inpatient stay (inpatient group) and patients discharged on the day of surgery (day-case group). Univariate analysis was performed to identify factors associated with overnight stay. Reverse step-wise multivariate logistical regression was performed on pre-operative variables. A model was derived to predict day-case surgery vs. overnight stay. The model was evaluated using the receiver operating curve (ROC).
RESULTS: 387 patients were included in the analysis. Mean length of stay (LOS) was 0.47 nights +/- 0.87. 249 patients (64%) were discharged on the day of surgery and 138 (36%) required inpatient stay [116 (84%) LOS = 1 day, 22 (16%) LOS ≥ 2 days]. 69% of patients were female. The average age (years) and pre-operative BMI of patients undergoing LARS were 48.2 and 31.4, respectively. On univariate analysis, the variables associated with overnight stay were increasing age, female gender, functional limitation (ASA class III or IV), Medicare insurance type, later procedure start time, increasing procedure duration, and the completion of additional procedures at the time of LARS. A logistical model using only preoperative variables was created using female gender, Medicare insurance, and procedure start time. This model was evaluated using the ROC which demonstrated that with a threshold of 0.17, the model has a sensitivity of predicting overnight stay after LARS of 94.5%, and a negative predictive value (NPV) of 81.6%. The 30 day readmission rate was not significant between the inpatient group (5.1%) and the day-case group (4.0%) [p=0.627].
CONCLUSION: Overnight stay after LARS is associated with increasing age, female gender, functional limitation (ASA class III or IV), Medicare insurance type, later procedure start time, additional procedures, and longer procedure duration. Variables available at the time of the pre-operative evaluation including female gender, Medicare insurance type, and procedure start time can be used to predict patients with a higher risk of overnight admission. These parameters may help guide appropriate use of hospital resources for LARS.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87303
Program Number: P395
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster