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Cheng S, Lee PC, Sim JXL, Tan AS, Ng CLW, Foo AXY, Abdullah HRB, Tan JTH, Ong HS, Lim CH. Cost-savings of short stay sleeve gastrectomy and walk-in hydration clinic versus conventional inpatient care. Surg Endosc 2023; 37:8349-8356. [PMID: 37700012 DOI: 10.1007/s00464-023-10414-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/12/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE We aim to evaluate the cost-saving of the short stay ward (SSW) versus conventional inpatient care following sleeve gastrectomy (LSG). We also compared the readmission rates pre- and post-inception of the intravenous hydration clinic and analyzed the cost-savings. METHODS Patients who underwent LSG between December 2021 to March 2022 with SSW care were compared with standard inpatient care. Total costs were analyzed using univariate analysis. With a separate cohort of patients, 30-day readmission rates in the 12-months preceding and following implementation of the IV hydration clinic and associated cost-savings were evaluated. RESULTS After matching on the propensity score to within ± 0.1, 20-subjects pairs were retained. The total cost per SSW-subject was significantly lower at $13,647.81 compared to $15,565.27 for conventional inpatient care (p = 0.0302). Lower average ward charges ($667.76 vs $1371.34, p < 0.0001), lower average daily treatment fee per case ($235.68 vs $836.54, p < 0.0001), and lower average laboratory investigation fee ($612.31 vs $797.21, p < 0.0001) accounted for the difference in costs between the groups. Thirty-day readmission rate reduced from 8.9 to 1.8% after implementation of the hydration clinic (p < 0.01) with decreased 30-day readmission cost (S$96,955.57 vs. S$5910.27, p < 0.01). CONCLUSION SSW for LSG is cost-effective and should be preferred to inpatient management. Walk-in hydration clinics significantly reduced readmission rates and result in tremendous cost-savings.
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Affiliation(s)
- Stephanie Cheng
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Level 5; Academia, 20 College Road, Singapore, 169856, Singapore
| | - Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Jacqueline X L Sim
- Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore
| | - Ai Shan Tan
- Department of Dietetics, Singapore General Hospital, Singapore, Singapore
| | - Cindy L W Ng
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | - Angelina X Y Foo
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | | | - Jeremy T H Tan
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Level 5; Academia, 20 College Road, Singapore, 169856, Singapore
| | - Hock Soo Ong
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Level 5; Academia, 20 College Road, Singapore, 169856, Singapore
| | - Chin Hong Lim
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Level 5; Academia, 20 College Road, Singapore, 169856, Singapore.
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Teh SH, Schecter SC, Servais EB, Liu K, Svahn J, Yang L, Goodstein M, Parent R, Chau E, Chang L, Zhou M, Shiraga S, Knox M. Same-Day Home Recovery for Benign Foregut Surgery. JAMA Surg 2022; 157:2796290. [PMID: 36103170 PMCID: PMC9475440 DOI: 10.1001/jamasurg.2022.4245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/18/2022] [Indexed: 09/16/2023]
Abstract
Importance Same-day home recovery (SHR) is now the standard of care for many major surgical procedures and has the potential to become standard practice for benign foregut procedures (eg, hiatal hernia repair, fundoplication, and Heller myotomy). Objective To determine whether SHR for patients undergoing benign foregut surgery is feasible, safe, and effective. Design, Setting, and Participants This prospective cohort study took place across 19 medical centers within an integrated health care system in northern California from January 2019 through September 2021. Participants included consecutive patients undergoing elective benign foregut surgery. Exposures Standardized SHR program. Main Outcomes and Measures The primary end point was the rate of SHR. The secondary end points were 7-day and 30-day rates of postoperative emergency department visits, hospital readmissions, and reoperations. Results Of 1248 patients who underwent benign foregut surgery from January 2017 through September 2021, 558 were patients before implementation of the SHR program and 690 were patients postimplementation. The mean age of patients was 60 years, and 759 (59%) were female. The preimplementation SHR rate was 64 of 558 patients (11.5%) in 2018 and increased to 82 of 113 patients (72.6%) by 2021 (94/350 [26.9%] in 2019 and 112/227 [49.3%] in 2020; P < .001). There were no statistical differences in the 7-day and 30-day rates of postoperative emergency visits, hospital readmissions, and reoperations or 30-day mortality in the SHR vs non-SHR groups in the postimplementation era. Conclusions and Relevance In this study, implementation of a regional SHR program among patients undergoing elective benign foregut surgery was feasible, safe, and effective. The changes in perioperative care require comprehensive patient education and full multidisciplinary support. An SHR program for benign foregut procedures has the potential to improve patient care and cost-effectiveness in care delivery.
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Affiliation(s)
- Swee H. Teh
- The Permanente Benign Foregut Surgery Group, Northern California Kaiser Permanente, Oakland
| | - Samuel C. Schecter
- The Permanente Benign Foregut Surgery Group, Northern California Kaiser Permanente, Oakland
| | - Edgar B. Servais
- TPMG Consulting Services, The Permanente Medical Group, Oakland, California
| | - Kingsway Liu
- The Permanente Benign Foregut Surgery Group, Northern California Kaiser Permanente, Oakland
| | - Jonathan Svahn
- The Permanente Benign Foregut Surgery Group, Northern California Kaiser Permanente, Oakland
| | - Lisa Yang
- The Permanente Benign Foregut Surgery Group, Northern California Kaiser Permanente, Oakland
| | - Monica Goodstein
- The Permanente Benign Foregut Surgery Group, Northern California Kaiser Permanente, Oakland
| | - Richard Parent
- The Permanente Benign Foregut Surgery Group, Northern California Kaiser Permanente, Oakland
| | - Edward Chau
- The Permanente Benign Foregut Surgery Group, Northern California Kaiser Permanente, Oakland
| | - Lynn Chang
- The Permanente Benign Foregut Surgery Group, Northern California Kaiser Permanente, Oakland
| | - Minhoa Zhou
- The Permanente Benign Foregut Surgery Group, Northern California Kaiser Permanente, Oakland
| | - Sharon Shiraga
- The Permanente Benign Foregut Surgery Group, Northern California Kaiser Permanente, Oakland
| | - Michelle Knox
- TPMG Consulting Services, The Permanente Medical Group, Oakland, California
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Parker B, Beard K, Fletcher R, Sharata A, Muller D, Haisley K, Reavis K, Davila Bradley D, DeMeester S, Swanström L, Dunst C. Can We Identify Patients Appropriate for Same-Day Discharge After Laparoscopic Fundoplication? J Laparoendosc Adv Surg Tech A 2021; 32:132-136. [PMID: 33797982 DOI: 10.1089/lap.2020.0929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Patients, surgeons, and payers are interested in reducing hospital length of stay. Outpatient laparoscopic fundoplication (LF) can be done safely and cost effectively. There is low acceptance of this practice due to fear of readmission and patient dissatisfaction. Our aim was to identify factors predicting failure of same-day discharge after LF. Methods and Procedures: We simulated an outpatient setting for patients who underwent LF from 2017 to 2018 and collected the data prospectively. A perioperative pain and nausea protocol was utilized. Postoperatively, patients were given a liquid diet and oral medications, observed overnight, and then discharged after standard criteria were met. Failure was defined by the need for physician intervention after 3 hours or failure to discharge. Univariate and multivariable logistic regression analyses were performed assessing factors associated with failure. Two-sample t-test and chi-squared tests were used for significance. Results: Ninety-eight patients were included. Twenty patients failed, primarily due to the need for intravenous medications. Seven were discharged on postoperative day 1 but required physician intervention after 3 hours. Thirteen patients stayed >23 hours. Two patients were readmitted within 1 week of discharge. There was one acute recurrence, requiring reoperation, and one conversion to laparotomy. We found no statistically significant patient risk factor, comorbidity, or perioperative variable that could reliably predict failure of same-day discharge. Conclusion: This study suggests that same-day discharge after LF is safe and feasible. However, 20% of patients will unpredictably fail to meet discharge criteria.
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Affiliation(s)
- Brett Parker
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA.,Division of Minimally Invasive Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kristin Beard
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Reid Fletcher
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Ahmed Sharata
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Dolores Muller
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Kelly Haisley
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Kevin Reavis
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Daniel Davila Bradley
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Steven DeMeester
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Lee Swanström
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Christy Dunst
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
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Yuce TK, Ellis RJ, Merkow RP, Soper NJ, Bilimoria KY, Odell DD. Post-operative complications and readmissions following outpatient elective Nissen fundoplication. Surg Endosc 2019; 34:2143-2148. [PMID: 31388808 DOI: 10.1007/s00464-019-07020-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/19/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Traditionally, laparoscopic Nissen fundoplication (LNF) has been considered an inpatient procedure. Advances in surgical and anesthetic techniques have led to a shift towards outpatient LNF procedures. However, differences in surgical outcomes between outpatient and inpatient LNF are poorly understood. The objectives of this study were (1) to describe the frequency of outpatient LNF in a national cohort and (2) to identify any differences in complications or readmission rates between outpatient and inpatient LNF. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify elective LNF cases from 2012 to 2016. Patients discharged on the day of surgery were compared to those discharged 24-48 h post-operatively. Outcomes included 30-day readmission and death or serious morbidity (DSM). Bivariate analyses were completed with Chi squared testing for categorical variables and two sided t tests for continuous variables. Associations between outpatient surgery and outcomes were assessed using multivariable logistic regression. Differences in readmission were analyzed using Kaplan-Meier failure estimates and log-rank tests. RESULTS Of 7734 patients who underwent elective LNF, 568 (7.3%) were discharged on the day of surgery. The overall 30-day readmission rate was 4.1% (n = 316) and the overall rate of DSM was 1.0% (n = 79). The most common 30-day readmission diagnoses overall were infectious complications (16.1%), dysphagia (12.9%), and abdominal pain (11.7%). On multivariable analysis, there was no association between outpatient surgery and 30-day readmission (3.9% vs. 4.1%; aOR 0.97, 95% CI 0.62-1.52, p = 0.908) or DSM (1.1% vs. 1.0%; aOR 0.91, 95%CI 0.36-2.29, p = 0.848). Kaplan-Meier analysis showed no difference in rates of hospital readmission between groups at 30-days from discharge (3.9% vs. 4.1%, p = 0.325). CONCLUSIONS Among patients undergoing elective LNF, there were no significant differences in post-operative complications and 30-day readmission when compared to traditional inpatient postoperative care. Further consideration should be given to transitioning LNF to an outpatient procedure.
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Affiliation(s)
- Tarik K Yuce
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N St Clair St, 20th Floor, Chicago, IL, 60611, USA.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ryan J Ellis
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N St Clair St, 20th Floor, Chicago, IL, 60611, USA.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ryan P Merkow
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N St Clair St, 20th Floor, Chicago, IL, 60611, USA.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nathaniel J Soper
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N St Clair St, 20th Floor, Chicago, IL, 60611, USA.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - David D Odell
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N St Clair St, 20th Floor, Chicago, IL, 60611, USA. .,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Northwestern Institute for Comparative Effectiveness Research in Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Rebibo L, Dhahri A, Badaoui R, Hubert V, Lorne E, Regimbeau JM. Laparoscopic sleeve gastrectomy as day-case surgery: a case-matched study. Surg Obes Relat Dis 2019; 15:534-545. [DOI: 10.1016/j.soard.2019.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 11/07/2018] [Accepted: 02/11/2019] [Indexed: 12/25/2022]
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Rebibo L, Maurice KK, Nimier M, Ben Rehouma M, Montravers P, Msika S. Laparoscopic sleeve gastrectomy as day-case surgery: a review of the literature. Surg Obes Relat Dis 2019; 15:1211-1217. [PMID: 31060908 DOI: 10.1016/j.soard.2019.03.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/03/2019] [Accepted: 03/10/2019] [Indexed: 10/27/2022]
Abstract
Day-case surgery (DCS) in digestive surgery is a hot topic, and new indications for DCS in the field of gastrointestinal surgery have recently been described. Laparoscopic sleeve gastrectomy (LSG) has become a popular bariatric procedure in recent years. LSG is a reproducible, standardized procedure with a short operating time and possibly simple perioperative management. It therefore meets the criteria to be performed as a DCS procedure. Recently published series of LSG as DCS have demonstrated its feasibility. In this review on LSG performed as DCS, we focused on the management of risks associated with DCS and the results of such type of management. A literature search was conducted in the PubMed and Embase databases. Six studies were selected, comprising a total of 6227 patients. Most published series were retrospective single-center studies. Inclusion criteria were similar between most studies (primary sleeve gastrectomy for most series, patients with a body mass index ≥40 kg/m2 or a body mass index ≥35 kg/m2 in the presence of co-morbidities), while exclusion criteria were based on literature data for some studies (using series on risk factors for morbidity and mortality after Roux-en-Y gastric bypass) and personal experience for other series. The mortality rate of LSG as DCS ranges 0%-.08%, while the overall complication rate ranges 0%-10%. The unplanned overnight admission rate after LSG ranges .8%-8%. The unscheduled hospitalization rates range 2.1%-8.5%. LSG performed as DCS is feasible with good results, but cannot be proposed for all patients. Good selection is necessary in others to avoid increased risk of morbidity and mortality.
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Affiliation(s)
- Lionel Rebibo
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, Paris, France; Université Paris Diderot - Sorbonne Paris Cité, Paris, France
| | - Karim K Maurice
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, Paris, France; Department of General and Digestive Surgery, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Martin Nimier
- Department of Anaesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, Paris, France
| | - Mouna Ben Rehouma
- Department of Anaesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, Paris, France
| | - Philippe Montravers
- Université Paris Diderot - Sorbonne Paris Cité, Paris, France; Department of Anaesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, Paris, France
| | - Simon Msika
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, Paris, France; Université Paris Diderot - Sorbonne Paris Cité, Paris, France.
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7
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Rebibo L, Leourier P, Badaoui R, Le Roux F, Lorne E, Regimbeau JM. Minor laparoscopic liver resection as day-case surgery (without overnight hospitalisation): a pilot study. Surg Endosc 2019; 33:261-271. [PMID: 29943064 DOI: 10.1007/s00464-018-6306-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/18/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Day-case surgery (DCS) has become increasingly popular over recent years, as has laparoscopic liver resection (LLR) for the treatment of benign or malignant liver tumours. The purpose of this prospective study was to demonstrate the feasibility of minor LLR as DCS. METHODS Prospective, intention-to-treat, non-randomised study of patients undergoing minor LLR between July 2015 and December 2017. Exclusion criteria were resection by laparotomy, major LLR, difficult locations for minor LLR, history of major abdominal surgery, hepatobiliary procedures without liver parenchyma resection, cirrhosis with Child > A and/or portal hypertension, significant medical history and exclusion criteria for DCS. The primary endpoint was the unplanned overnight admission rate. Secondary endpoints were the reason for exclusion, complication data, criteria for DCS evaluation, satisfaction and compliance with the protocol. RESULTS One hundred sixty-seven patients underwent liver resection during the study period. LLR was performed in 92 patients (55%), as DCS in 23 patients (25%). Reasons for minor LLR were liver metastasis (n = 9), hepatic adenoma (n = 5), hepatocellular carcinoma (n = 4), ciliated hepatic foregut cyst (n = 2) and other benign tumours (n = 3). All day-case minor LLR, except two patients, consisted of single wedge resection, while one patient underwent left lateral sectionectomy. There were four unplanned overnight admissions (17.4%), one unscheduled consultation (4.3%), two hospital readmissions (8.6%) and no major complications/mortality. Compliance with the protocol was 69.5%. Satisfaction rate was 91%. CONCLUSION In selected patients, day-case minor LLR is feasible with acceptable complication and readmission rates. Day-case minor LLR can therefore be legitimately proposed in selected patients.
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Affiliation(s)
- Lionel Rebibo
- Department of Digestive Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France
| | - Pauline Leourier
- Department of Digestive Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France
| | - Rachid Badaoui
- Department of Anaesthesiology, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France
| | - Fabien Le Roux
- Department of Digestive Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France
| | - Emmanuel Lorne
- Department of Anaesthesiology, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France.,SSPC (Simplification des Soins des Patients Complexes) - Clinical Research Unit, University of Picardie Jules Verne, 80054, Amiens Cedex 01, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France. .,SSPC (Simplification des Soins des Patients Complexes) - Clinical Research Unit, University of Picardie Jules Verne, 80054, Amiens Cedex 01, France. .,Service de chirurgie digestive, Hôpital Sud, CHU d'Amiens, Avenue René Laennec, 80054, Amiens Cedex 01, France.
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8
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Mistry P, Zaman S, Shapey I, Daskalakis M, Nijjar R, Richardson M, Super P, Singhal R. Building a model for day case hiatal surgery - Lessons learnt over a 10 year period in a high volume unit: A case series. Int J Surg 2018; 54:82-85. [PMID: 29704563 DOI: 10.1016/j.ijsu.2018.04.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 03/23/2018] [Accepted: 04/23/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Laparoscopic anti-reflux surgery has become the standard treatment for symptomatic gastro-oesophageal reflux disease refractory to medical therapy. Successful anti-reflux surgery involves safe, minimally invasive surgery, resulting in symptom resolution with minimal side effects. This study aims to assess the feasibility and safety of day case anti-reflux surgery focussing on peri- and post-operative outcomes as a measure of success. METHODS Data was collected from the hospital database from 2003 to 2012. Data collection included demographics, surgeon, mode of admission, length of stay and complications. Electronic records were independently scrutinised for all patients with a length of stay of more than two nights. RESULTS 723 patients underwent laparoscopic fundoplication ± small hiatus hernia repair (<5 cm) with a day case rate of 67.1%. The 30 day readmission rate in these patients was 2.9% (21/723 patients). Nine patients had a failure of their initial laparoscopic fundoplication (defined as recurrence of symptoms). Three patients required a re-operation within 12 months of their initial procedure (re-operation rate = 0.41% (3/723 patients)). CONCLUSION Laparoscopic hiatal surgery can be performed safely as a day case in high volume specialist centres with good outcomes. Raising the national standard for day case fundoplication promotes good practice and should be the model for future commissioning.
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Affiliation(s)
- Pritesh Mistry
- Upper GI & Minimally Invasive Unit, Heart of England NHS Foundation Trust, Birmingham, UK.
| | - Shafquat Zaman
- Upper GI & Minimally Invasive Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Iestyn Shapey
- Department of Transplantation, Manchester Royal Infirmary, Manchester, UK
| | - Markos Daskalakis
- Upper GI & Minimally Invasive Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Rajwinder Nijjar
- Upper GI & Minimally Invasive Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Martin Richardson
- Upper GI & Minimally Invasive Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Paul Super
- Upper GI & Minimally Invasive Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Rishi Singhal
- Upper GI & Minimally Invasive Unit, Heart of England NHS Foundation Trust, Birmingham, UK
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9
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Molina JC, Misariu AM, Nicolau I, Spicer J, Mulder D, Ferri LE, Mueller CL. Same day discharge for benign laparoscopic hiatal surgery: a feasibility analysis. Surg Endosc 2017; 32:937-944. [PMID: 28779258 DOI: 10.1007/s00464-017-5769-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/14/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Advances in minimally invasive surgery and the development of enhanced recovery pathways have favored the spread of day-surgery programs. Despite laparoscopic approaches being accepted as the standard of care for benign hiatal diseases, safety and feasibility of same day discharges for laparoscopic hiatal surgeries other than fundoplication has yet to be established. OBJECTIVE This study aimed to assess the feasibility of same day discharge for primary and revisional laparoscopic hiatal surgeries including paraesophageal hernia repairs (PEHR), fundoplication for reflux, and Heller myotomy (±diverticulectomy). METHODS A retrospective cohort study including all patients undergoing elective laparoscopic hiatal procedures in the division of Thoracic surgery between 2011 and 2016 at McGill University Health Centre was performed. Planned day-surgery (DAYCASE) was compared to planned inpatient (INPATIENT) cohorts with respect to operative and postoperative outcomes, length of stay, readmission, and emergency room visits. RESULTS A total of 261 patients were identified, 161 female (62%); median age 62 (20). The case distribution was: PEHR (123; 47.1%), Heller myotomy (94;36%, 7 diverticulectomy), and fundoplication (44; 16.9%). Twenty patients had revisional procedures (7.7%). Same day discharge was planned in 98 cases (38%) and was successful in 80 (81.6%). Proportion of DAYCASE increased form 12% prior to 2013 to 67% in 2016. INPATIENTs were older (median 66 vs. 60 years), and had a higher proportion of PEHR (55 vs. 34%), p < 0.05. Both cohorts were comparable in gender proportion, ASA classification, and length of surgery. Complications, readmission, and emergency visits did not differ between the two cohorts. On multivariate analysis, female gender (OR 37, 95% CI 1.46-936, p = 0.028), surgery beginning after noon (OR 5.4, 95% CI 1.1-26.9, p = 0.038), intraoperative complications (OR 20.4 95% CI 1.5-286, p = 0.025), and postoperative complications (OR 52.1, 95% CI 4.5-602, p = 0.002) were independently associated with unplanned admission. CONCLUSIONS Day-case surgery for complex laparoscopic hiatal procedures is feasible and can be achieved in a significant number of patients without compromising safety.
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Affiliation(s)
- Juan Carlos Molina
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada.
| | - Ana María Misariu
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada
| | - Ioana Nicolau
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada
| | - Jonathan Spicer
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada
| | - David Mulder
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada
| | - Lorenzo E Ferri
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada
| | - Carmen L Mueller
- Division of Thoracic and Upper GI Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, L8-512, Montreal, QC, H3G 1A4, Canada
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10
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Desbeaux A, Gronnier C, Piessen G, Vanderbeken M, Ruolt N, Triboulet JP, Mariette C. Same-day discharge in benign esophageal surgery: a prospective cohort study. Dis Esophagus 2017; 30:1-7. [PMID: 28375480 DOI: 10.1093/dote/dow036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Indexed: 12/11/2022]
Abstract
Day-case esophageal surgery has been demonstrated to be safe in small prospective cohorts and only for laparoscopic fundoplication. The aims of this study are to assess the feasibility and safety of a large series of esophageal day-case surgeries, including laparoscopic Nissen fundoplication (LNF), Zenker diverticulectomy (ZD), and laparoscopic Heller myotomy (LHM) and to compare the outcomes among three procedures.This was a prospective, observational study of selected patients who underwent day-case LNF, ZD, and LHM between 2003 and 2013. Postoperative outcomes, the patients' satisfaction, and functional results were evaluated with dedicated scores and compared.Of the 427 patients who underwent surgery for those indications during the study period, 168 (39.3%) eligible patients underwent day-case procedures (134 LNF, 14 LHM, and 20 ZD). The overnight unplanned admission rate was 16.2% and was similar among the groups (P = 0.681). Ten patients were readmitted during the first postoperative week because of dysphagia (n = 6, all in the LNF group), flu-like syndrome (n = 1), and secondary perforation (n = 3, all in the LHM group). The unplanned seven-day readmission rate was significantly higher in the LHM group than in the ZD and LNF groups (P = 0.042). The 30-day rates of unplanned readmission and consultation were 8.9% (P = 0.300) and 4.8%, respectively. At follow-up, 87.5% of the patients were satisfied with day-case treatment, and the functional results were good for 81.4% of the patients.Day-case esophageal surgery is feasible for LNF and seems to be feasible for ZD. Safety criteria have not yet been met for LHM, requiring further adaptations.
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Affiliation(s)
- A Desbeaux
- Univ. Lille, Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille, France.,Univ. Lille, Ambulatory Department, University Hospital Claude Huriez, Lille, France
| | - C Gronnier
- Univ. Lille, Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille, France.,Univ. Lille, Ambulatory Department, University Hospital Claude Huriez, Lille, France.,Univ. Lille, UMR-S 1172 - JPARC - Centre de Recherche Jean Pierre Aubert Neuroscience et Cancer, F-59000 Lille, France
| | - G Piessen
- Univ. Lille, Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille, France.,Univ. Lille, Ambulatory Department, University Hospital Claude Huriez, Lille, France.,Univ. Lille, UMR-S 1172 - JPARC - Centre de Recherche Jean Pierre Aubert Neuroscience et Cancer, F-59000 Lille, France
| | - M Vanderbeken
- Univ. Lille, Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille, France.,Univ. Lille, Ambulatory Department, University Hospital Claude Huriez, Lille, France
| | - N Ruolt
- Univ. Lille, Ambulatory Department, University Hospital Claude Huriez, Lille, France
| | - J-P Triboulet
- Univ. Lille, Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille, France.,Univ. Lille, Ambulatory Department, University Hospital Claude Huriez, Lille, France
| | - C Mariette
- Univ. Lille, Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille, France.,Univ. Lille, Ambulatory Department, University Hospital Claude Huriez, Lille, France.,Univ. Lille, UMR-S 1172 - JPARC - Centre de Recherche Jean Pierre Aubert Neuroscience et Cancer, F-59000 Lille, France
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Laparoscopic sleeve gastrectomy as day-case surgery (without overnight hospitalization). Surg Obes Relat Dis 2014; 11:335-42. [PMID: 25614354 DOI: 10.1016/j.soard.2014.08.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 08/15/2014] [Accepted: 08/29/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Day-case surgery (DCS) has boomed over recent years, as has laparoscopic sleeve gastrectomy (SG) for the treatment of morbid obesity. The objective of this study was to evaluate the safety and feasibility of day-case SG. METHODS This was a prospective, nonrandomized study of 100 patients undergoing day-case SG from May 2011 to July 2013. All patients met the criteria for DCS and for the treatment of morbid obesity. Standard surgical, anesthetic, and analgesic protocols were used. The primary study endpoint was the unplanned overnight admission rate. Secondary endpoints were standard DCS criteria, frequency and type of complications, and satisfaction rate of performing day-case SG. The short-term postoperative course of patients undergoing day-case and conventional SG also were compared. RESULTS A total of 416 patients were screened and 100 (24%) were included. There were 8 unplanned overnight admissions. Seven unexpected consultations, 7 hospital readmissions, and 5 major complications were recorded, including 3 cases of unexpected surgery for gastric leak. At follow-up, 96% of the patients were satisfied with day-case SG. The short-term postoperative course was similar among patients undergoing DCS and conventional management. CONCLUSION In selected patients, day-case SG is feasible with acceptable complication and readmission rates. The postoperative course was similar to that observed for standard SG.
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Lessons Learned From Two Consecutive Cleft Lip and Palate Missions and the Impact of Patient Education. J Craniofac Surg 2014; 25:1610-3. [DOI: 10.1097/scs.0000000000000999] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Day-case versus inpatient laparoscopic fundoplication: outcomes, quality of life and cost-analysis. Surg Endosc 2014; 28:2159-66. [DOI: 10.1007/s00464-014-3448-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 01/13/2014] [Indexed: 01/13/2023]
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Abstract
INTRODUCTION Ambulatory management is a modality of care defined in France by a hospitalization of less than 12h without an overnight stay. Currently, few data are available on its role in the management of gastrointestinal emergencies, such as appendectomy for acute appendicitis, cholecystectomy for acute cholecystitis or emergency proctologic surgery. The aim of this systematic review was to study the published data regarding the feasibility of ambulatory management of emergency visceral surgery and to enquire about the possibilities of further development of this form of management. MATERIALS AND METHODS A literature search was conducted from the PubMed(®) databank taking into account all published data up to July 2013. RESULTS For acute appendicitis, the success rate of short-stay hospitalization was 72% with unplanned read-mission rates ranging from 0 to 53%, a rate of unscheduled consultations ranging from 0 to 11%, and unplanned inpatient hospitalization rates ranging from 0% to 5%. For acute cholecystitis and proctology, there are few published data. CONCLUSION Ambulatory management has been sparingly studied in the setting of gastrointestinal surgical emergencies. However, there is probably a place for development of this form of management.
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Brown JJ, Bawa S, Horgan LF, Attwood SE. Achieving Day-Case Laparoscopic Nissen Fundoplication: An Analysis of Patient and Operative Factors. J Laparoendosc Adv Surg Tech A 2013; 23:751-5. [DOI: 10.1089/lap.2013.0187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Jamie J.S. Brown
- Department of Surgery, Northumbria Healthcare NHS Trust, North Tyneside General Hospital, Tyne and Wear, United Kingdom
| | - Sidaq Bawa
- Department of Surgery, Northumbria Healthcare NHS Trust, North Tyneside General Hospital, Tyne and Wear, United Kingdom
| | - Liam F. Horgan
- Department of Surgery, Northumbria Healthcare NHS Trust, North Tyneside General Hospital, Tyne and Wear, United Kingdom
| | - Stephen E. Attwood
- Department of Surgery, Northumbria Healthcare NHS Trust, North Tyneside General Hospital, Tyne and Wear, United Kingdom
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Thomas H, Agrawal S. Systematic review of day-case laparoscopic fundoplication. J Laparoendosc Adv Surg Tech A 2011; 21:781-8. [PMID: 21942361 DOI: 10.1089/lap.2011.0276] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of the current study is to review published literature on day-case laparoscopic fundoplication in adults. DATA SOURCES Medline, Embase, and Cochrane library was searched by using the medical subjects headings "ambulatory surgical procedures" and "fundoplication" with further free text search and cross references. All articles on planned day-case laparoscopic fundoplication that described patient selection criteria, same-day discharge, complications, and readmissions were reviewed. CONCLUSIONS Thirteen cohort studies were included in this review. Ten were on planned same-day discharge with a 93% (739 out of 792) success, 4% (34) complication, and 5% (39) readmission rate. Three studies were on planned 23 hour discharge with a 98% (571 out of 583) success, 4% (25) complications, and 1% (5) re-admission rate. Nausea, pain, fatigue, and pneumothorax were the commonest causes for overnight admission. Dysphagia and pain were the main reasons for readmission. Most patients were satisfied with day-case laparoscopic fundoplication.
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Affiliation(s)
- Harun Thomas
- The Academic Unit of Surgical Gastroenterology, Homerton University Hospital NHS Trust, London, United Kingdom
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Ambulatory laparoscopic fundoplication for gastroesophageal reflux disease: a systematic review. Surg Endosc 2011; 25:2859-64. [PMID: 21487865 DOI: 10.1007/s00464-011-1682-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 03/14/2011] [Indexed: 12/30/2022]
Abstract
BACKGROUND Ambulatory laparoscopic fundoplication for gastroesophageal reflux disease (GERD) has been developed in order to increase patients' satisfaction and to save bed costs. The aim of this systematic review was to assess the advantages and disadvantages of ambulatory surgery in patients undergoing elective fundoplication for GERD. METHODS Two reviewers independently searched and identified 15 prospective or retrospective nonrandomized studies dealing with ambulatory laparoscopic fundoplication for GERD in the Medline, Cancerlit, and Embase databases between January 1990 and July 2010. Outcomes were postoperative mortality, morbidity, conversion and reoperation rates, mean operative time, hospital admission or readmission, unexpected consultation, and patient satisfaction. Because only one comparative study was identified, data compilation and relative risk evaluation through meta-analysis were not possible. RESULTS A total of 1459 adult patients underwent an ambulatory laparoscopic fundoplication for GERD, 876 in a day-case setting and 583 in an outpatient setting. The procedure appears feasible for selected patients and expert surgeons, and it has a very low mortality rate and conversion, reoperation, and overall morbidity rates of 3.6, 0.6, and 11.1%, respectively. Hospital admission, nonprogrammed consultation, and hospital readmission rates were as high as 20, 11, and 12%, respectively. No study looked at comparative long-term functional results between ambulatory and inpatient procedures. Patient satisfaction rates based on self-evaluation were high. CONCLUSION The data available to date in the literature, mostly of level 4 evidence, suggest that laparoscopic fundoplication for GERD appears to be safe and feasible in a day-surgery setting, subject to careful patient selection and surgeon expertise. Randomized control trials are urgently needed to better evaluate this promising care management.
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Thomas H, Agrawal S. Systematic Review of Same-Day Laparoscopic Adjustable Gastric Band Surgery. Obes Surg 2011; 21:805-10. [DOI: 10.1007/s11695-011-0384-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ramírez-Plaza CP, Gallego Perales JL, Camero NM, Rodríguez-Cañete A, Bondía-Navarro JA, Santoyo-Santoyo J. Outpatient laparoscopic adrenalectomy: a new step ahead. Surg Endosc 2011; 25:2570-3. [DOI: 10.1007/s00464-011-1588-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Accepted: 01/13/2011] [Indexed: 11/24/2022]
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Prospective study of routine day-case laparoscopic modified Lind partial fundoplication. World J Surg 2009; 33:1229-34. [PMID: 19363692 DOI: 10.1007/s00268-009-0026-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim of the present study was to prospectively assess the feasibility, safety, and acceptability of performing day-case laparoscopic modified Lind fundoplication for gastroesophageal reflux disease on a routine basis and to determine possible implications for health care costs to the hospital. METHODS All patients undergoing laparoscopic fundoplication between November 2005 and November 2007 under the care of one surgeon were included in the study. Inclusion criteria were American Society of Anesthesiologists (ASA) grade I and II with adequate home support. The surgical procedure was laparoscopic modified Lind fundoplication in all the cases. Patients were reviewed in the clinic at 6 weeks and were subsequently assessed through a structured postal questionnaire at a median of 1 year. RESULTS Over the 25-month period, a total of 130 laparoscopic modified Lind fundoplications were performed, of which 103 (79.2%) met the inclusion criteria for day-case surgery. The patients were 16 to 75 years of age. Ninety (87.4%) were discharged on the same day as planned, and 11 patients were admitted overnight because of nausea. At clinic follow-up at a median of 6 weeks all patients expressed satisfaction and were reflux free. There was a significant reduction of mean modified Visick score and visual analog scale for reflux at a median of 1 year after surgery. CONCLUSIONS Routine day-case laparoscopic modified Lind fundoplication for gastroesophageal reflux disease is safe and well tolerated, with high levels of patient satisfaction and reduced costs to the hospital. Patients with ASA grade >2 and redo antireflux surgery should not be considered for day-case surgery. Hospital readmission was required in less than 3% of patients after discharge home, but those readmissions were not related to early discharge on the same day of surgery.
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Lo S, Stuenkel DL, Rodriguez L. The Impact of Diagnosis-Specific Discharge Instructions on Patient Satisfaction. J Perianesth Nurs 2009; 24:156-62. [DOI: 10.1016/j.jopan.2009.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 02/11/2009] [Accepted: 03/08/2009] [Indexed: 11/29/2022]
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Feasibility of laparoscopic Nissen fundoplication as a day-case procedure. Surg Endosc 2009; 23:1839-44. [PMID: 19118426 DOI: 10.1007/s00464-008-0277-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 11/11/2008] [Accepted: 12/02/2008] [Indexed: 01/11/2023]
Abstract
BACKGROUND The aim of this prospective double-cohort pilot study is to evaluate the feasibility and desirability of laparoscopic Nissen fundoplication (LNF) performed in day-care when compared with laparoscopic cholecystectomy (LC) in day-care. METHODS Patients who underwent a LNF in day-care were prospectively evaluated. LNF patients were treated according to LC in day-care protocol. Outcome parameters were EQ-5D, visual analogue scale (VAS), and patient satisfaction. RESULTS From October 2005 to March 2008, 22 patients underwent LNF and 48 patients LC in day-care. After LNF, 21 out of 22 (95%) patients were discharged the same day. Seven (32%) patients were seen postoperatively in the Emergency Department with dysphagia or pain and two (9%) patients were readmitted. After LC, 45 out of 48 (94%) patients were discharged the same day. Six (12.5%) patients were seen postoperatively in the Emergency Department because of wound infection or pain and three (6%) were readmitted. EQ-5D and VAS scores were significantly worse after LNF in day-care (repeated measurements, p < 0.0001 and p < 0.0001). In a telephone survey 66.7% preferred a short hospital stay over day-care surgery after LNF compared with 30.9% after LC (p = 0.011). CONCLUSIONS LNF in day-care is feasible and safe, but postoperative pain scores are high and most prefer short hospital stay.
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Abstract
Day-surgery setting allows to combine patients' satisfaction to cost-saving policies that seems to be more and more important for a modern hospital management. Minimally invasive surgery seems to be the ideal surgical approach for day-case procedures since, reducing trauma to a minimal level, allows patients to return quick to a normal life with minimal nursing assistance. Extensive review of the most recent article has been performed in this article in order to define the current evidences that support the use of laparoscopic surgery in a day-case setting. Laparoscopic cholecystectomy, anti-reflux procedure and hernia repair seems to be justified according to the results of the published data. Patients' selection and hospital organization seem to be mandatory in order to obtain successful results.
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