Implementation Of Same-day Discharge Protocol After Laparoscopic Fundoplication For Gastroesophageal Reflux Disease (GERD) Does Not Increase 30-day Complications
*Michelle Campbell1, *Hoover Wu1, *Julia R Amundson1, *Vanessa VanDruff1, *Kristine Kuchta2, H. Mason Hedberg2, Michael B Ujiki2
1University of Chicago Medicine, Chicago, IL;2NorthShore University HealthSystem, Evanston, IL
OBJECTIVE(S): Fundoplication is the standard of care operation for gastroesophageal reflux disease (GERD). This study reports post-operative outcomes at a single institution following implementation of a same-day discharge protocol after elective laparoscopic fundoplication.
METHODS: A retrospective cohort study including patients who underwent fundoplication for GERD on or after January 1, 2019 was performed. Revisions and paraesophageal hernia repair were excluded as ineligible for same-day discharge consideration. Peri-operative, 30-day post-operative, and quality of life (QOL) outcomes of patients successfully discharged same-day were compared to patients admitted post-operatively. Predictors of successful same-day discharge were identified using multivariable logistic regression.
RESULTS: A total of 61 patients were identified for inclusion between January 2019 and December 2021; 34 (55.7%) were successfully discharged same-day. Compared to admitted patients, patients discharged same-day were younger (56±13 vs. 65±11, p=0.006), more likely to have ASA classification 1 or 2 (82.4% vs. 59.3%, p=0.046), more often received Toupet fundoplication (97.1% vs. 66.7%, p=0.003), and had shorter operative time (102±35 vs. 112±27, p=0.027). There were no significant differences in intraoperative complications, 30-day complications, emergency visits, or readmissions. Symptom resolution, QOL scores, and satisfaction were similar between groups through 2-year follow-up (Figure 1).
Figure 1. Quality of life survey responses over time.
Multivariable analysis identified male sex (OR 4.14 (1.11-15.51), p=0.035), ASA class 1 or 2 (OR 4.14 (1.08-15.80), p=0.038), and Toupet fundoplication (OR 20.76 (2.54-169.42), p=0.005) as predictive of same-day discharge. Common reasons for admission included side effects from anesthesia and age > 65 years.
Compared to patients who underwent fundoplication in the two years prior to implementation of the same-day discharge protocol (January 2017 to December 2018), patients successfully discharged same-day after protocol implementation showed no significant differences in intraoperative complications, 30-day complications, emergency visits, or readmissions.
CONCLUSIONS: Patients undergoing elective primary laparoscopic fundoplication for GERD in the absence of paraesophageal hernia can be safely discharged home on the day of surgery without significant increase in 30-day complications.
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