Can We Identify Patients Appropriate for Same-Day Discharge After Laparoscopic Fundoplication?

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Health Services Research

Background:

• Reducing hospital length of stay is a priority for patients, surgeons, and payers.
• Outpatient laparoscopic fundoplication (LF) offers potential for safe and cost-effective care.
• Current low acceptance of outpatient LF stems from concerns about readmission and patient satisfaction.

Purpose of the Study:

• To identify factors predicting failure of same-day discharge after laparoscopic fundoplication.
• To evaluate the safety and feasibility of same-day discharge protocols for LF.

Main Methods:

• Prospective simulation of an outpatient setting for LF patients (2017-2018).
• Implementation of a perioperative pain and nausea protocol, followed by observation and discharge based on standard criteria.
• Univariate and multivariable logistic regression analyses to assess factors associated with discharge failure.

Main Results:

• Twenty of 98 patients (20%) failed same-day discharge, primarily due to requiring intravenous medications.
• No statistically significant patient risk factors, comorbidities, or perioperative variables reliably predicted discharge failure.
• While same-day discharge is feasible, unpredictability in patient outcomes was observed.

Conclusions:

• Same-day discharge following laparoscopic fundoplication is a safe and viable option.
• A significant percentage of patients unpredictably fail to meet same-day discharge criteria.
• Further research may be needed to refine patient selection or management protocols for outpatient LF.