Lauren Cardella, DO, Sophia Horattas, MD, Christopher R Daigle, MD, Charudutt Paranjape, MD. Cleveland Clinic Akron General
Introduction: Laparoscopic Nissen fundoplication procedures are a safe and effective option for definitive anti-reflux treatment in select patients; however, patient selection criteria for same day discharge remain unclear. A retrospective study was undertaken to evaluate Nissen fundoplication procedures performed on an ambulatory surgical care basis to investigate patient-specific factors contributing to success or failure of outpatient treatment.
Methods: Data was obtained via a retrospective chart review to assess patient characteristics on all patients who underwent laparoscopic Nissen fundoplication by a single surgeon between October 2016 and July 2017. Studied parameters were compared between same day discharge (SDD) and post-operative admission (POA) patients, and included length of stay, complication rate, readmission rate, operative time, age, sex, ASA score, and BMI.
Results: Forty-nine patients were evaluated with subsequent exclusion of three patients from this study for additional alternative intraoperative interventions. Of the forty-six patients included in the study, thirty-two (69.6%) made up the SDD group while fourteen (30.4%) were in the POA group. The mean age of the study participants was 56.4 years, (SDD 50.9±14.3yrs vs. POA 67.9±10.4yrs, p-value<0.05). Sixteen males (34.8%) and 30 females (65.2%) were included, and no postoperative mortalities occurred throughout the study duration. Average ASA score was similar between groups, with an average score of 2.4±0.5 (POA) compared to 2.2±0.5(SDD) (p=0.131). Operative duration averaged 105.8±26.6min in the POA group compared to 78.9±25.7min in the SDD group (p value<0.05). Mean BMI among SDD patients was 29.5±5.2 compared to 30.6±7.0 among POA patients (p value: 0.546). Within the SDD group, one patient (3.1%) was readmitted on postoperative day three for nausea and vomiting. This study reports a success rate of 67.4% for same day discharge, with an overall average length of stay of 7.2 hours. Of the fourteen patients admitted after surgery, 50% were admitted secondary to insurance reimbursement provisions.
Conclusion: Same-day discharge after Nissen fundoplication and hiatal hernia repair is feasible for select patients. One major challenge for same day discharge is the current insurance provisions required for hospital reimbursement. Within the parameters of this study, BMI and ASA score did not differ between discharged and admitted patients, while older age and increased procedure duration were associated with need for admission.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88053
Program Number: P352
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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