Post-operative complications and readmissions following outpatient elective Nissen fundoplication

Tarik K. Yuce, Ryan J. Ellis, Ryan Patrick Merkow, Nathaniel J Soper, Karl Y Bilimoria, David Duston Odell*

*Corresponding author for this work

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalSurgical endoscopy
DOIs
StatePublished - Jan 1 2019

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Fundoplication
Outpatients
Ambulatory Surgical Procedures
Inpatients
Morbidity
Patient Readmission
Postoperative Care
Deglutition Disorders
Quality Improvement
Abdominal Pain
Anesthetics
Logistic Models
Databases
Mortality

Keywords

  • Complications
  • Laparoscopic Nissen fundoplication
  • Outpatient
  • Readmission

ASJC Scopus subject areas

  • Surgery

Cite this

@article{877d495dba554a1d8209695eae3b3b7e,
title = "Post-operative complications and readmissions following outpatient elective Nissen fundoplication",
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.",
keywords = "Complications, Laparoscopic Nissen fundoplication, Outpatient, Readmission",
author = "Yuce, {Tarik K.} and Ellis, {Ryan J.} and Merkow, {Ryan Patrick} and Soper, {Nathaniel J} and Bilimoria, {Karl Y} and Odell, {David Duston}",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00464-019-07020-5",
language = "English (US)",
journal = "Surgical Endoscopy",
issn = "0930-2794",
publisher = "Springer New York",

}

TY - JOUR

T1 - Post-operative complications and readmissions following outpatient elective Nissen fundoplication

AU - Yuce, Tarik K.

AU - Ellis, Ryan J.

AU - Merkow, Ryan Patrick

AU - Soper, Nathaniel J

AU - Bilimoria, Karl Y

AU - Odell, David Duston

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Complications

KW - Laparoscopic Nissen fundoplication

KW - Outpatient

KW - Readmission

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U2 - 10.1007/s00464-019-07020-5

DO - 10.1007/s00464-019-07020-5

M3 - Article

JO - Surgical Endoscopy

JF - Surgical Endoscopy

SN - 0930-2794

ER -