Same day discharge does not lead to worse outcomes in patients undergoing uncomplicated laparoscopic foregut surgery

Abstract

Introduction With the advancement of minimally invasive surgical techniques surgeons have moved away from elective open foregut surgeries. Despite studies demonstrating the safety of same day discharge in appropriate patient populations, ambulatory surgery has yet to be established as the practice norm for patients undergoing uncomplicated laparoscopic foregut surgery. Methods The ACS-NSQIP database was queried from 2005 to 2018 for patients who had undergone elective and non-emergent laparoscopic Heller myotomy, fundoplication, and paraesophageal hernia repairs with and without mesh. The primary endpoints in this study included number and severity of complications as classified by the Clavien-Dindo Classification, readmission, and return to the operating room. Results 6893 patients who met inclusion criteria were identified, 696 (10.1%) of which were discharged on the day of surgery. Patients who were discharged on post-operative day one were matched at a 3:1 ratio producing 2088 comparisons. There was no difference in overall morbidity (p = 0.264), readmission (OR 0.849, 95% CI 0.522-1.419), or return to the operating room (OR 1.15,) between the two groups. Conclusion Same day discharge for patients without life threatening comorbidities undergoing elective minimally invasive Heller myotomy, Nissen and Toupet fundoplication, and paraesophageal hernia repairs is safe and feasible.

Is it Time to Embark on Laparoscopic Daycare Surgery in Resource-Limited Settings? Perspectives from a Series of Laparoscopic Heller’s Myotomy and Fundoplication for Achalasia Cardia

“…[9][10][11] Moreover, uncomplicated daycare laparoscopic upper GI surgeries (i.e., Heller's myotomy and fundoplication) have also been performed with low complication rates. 12,13 These cases, as presented, have shown comparable outcomes, except for longer hospital stays. Cullen et al, also examined the feasibility of daycare surgery at a specialized zonal hospital in Northern Tanzania, demonstrating a high rate of achievement.…”