Sophia S Oswald, Candice L Wilshire, MD, Brian E Louie, MD, Ralph W Aye, MD, Alexander S Farivar, MD. Swedish Medical Center
INTRODUCTION: Historically, standard post-operative management of patients undergoing laparoscopic hiatal hernia surgery has been placement of a foley catheter and nasogastric tube (NGT) at the time of surgery with removal early on postoperative day (POD) one, at which time an upper-gastrointestinal series study (UGI) would be performed. We initiated a quality improvement project, seeking to assess if we could safely forego placement of foley and NGT along with the UGI, unless clinically indicated. Our aim was to determine if this decreased overall length of stay (LOS), and how often and which demographic of patients needed placement of foley or NGT postoperatively.
METHODS AND PROCEDURES: We reviewed patients who had undergone laparoscopic hiatal hernia surgery between 2010 and 2016 under a single thoracic surgeon. Patients were excluded for poor esophageal motility (peristalsis <70%), previous esophageal surgery, and presence of a paraesophageal hernia (PEH) with over 50% of the stomach contained in the chest. Eligible patients were further stratified into two groups: fast track and non-fast track. Fast track was defined as patients who left the operating room (OR) with no foley or NGT, and did not receive a routine UGI on POD one. Non-fast track was defined as patients who left the OR with a foley and NGT and received a routine UGI on POD one. LOS was measured in hours from the start of surgery to the time of discharge.
RESULTS: Of the 75 patients included, 42 were categorized as fast track and 33 as non-fast track. The two groups were similar in terms of age, gender, BMI and ASA; however, the fast track group had fewer paraesophageal hernias and shorter surgery times [Table]. The hospital LOS, however, was significantly shorter in the fast track group, even though there were more postoperative urinary catheters utilized. No patients in fast track group needed an NGT placed or UGI ordered during initial stay.
CONCLUSION: In more straightforward laparoscopic hiatal hernia surgery, surgeons can safely forego NGT and foley placement, as well as UGI evaluation the following morning. These initiatives may translate to a quicker discharge from the ward, and may allow safe transition to performing these cases in 24 hour ambulatory outpatient setting. Further evaluation of additional interventions and patient education to decrease LOS are underway.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87913
Program Number: P741
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster