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.
Surg Endosc. 2020 May;34(5):2143-2148. doi: 10.1007/s00464-019-07020-5. Epub 2019 Aug 6.
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.
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.
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).
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.
传统上，腹腔镜 Nissen 胃底折叠术（LNF）被认为是一种住院手术。手术和麻醉技术的进步使得 LNF 手术向门诊手术转变。然而，门诊和住院 LNF 之间手术结果的差异尚未得到充分理解。本研究的目的是：（1）描述全国队列中门诊 LNF 的频率；（2）确定门诊和住院 LNF 之间并发症或再入院率的任何差异。
美国外科医师学院国家外科质量改进计划（ACS-NSQIP）数据库用于确定 2012 年至 2016 年的择期 LNF 病例。比较当天出院的患者与术后 24-48 小时出院的患者。结果包括 30 天再入院和死亡或严重发病率（DSM）。对于分类变量，使用卡方检验进行双变量分析，对于连续变量，使用双侧 t 检验。使用多变量逻辑回归评估门诊手术与结果之间的关联。使用 Kaplan-Meier 失败估计和对数秩检验分析再入院差异。
在 7734 例接受择期 LNF 的患者中，568 例（7.3%）在手术当天出院。总的 30 天再入院率为 4.1%（n=316），总的 DSM 率为 1.0%（n=79）。总体而言，最常见的 30 天再入院诊断是感染并发症（16.1%）、吞咽困难（12.9%）和腹痛（11.7%）。多变量分析显示，门诊手术与 30 天再入院（3.9%与 4.1%；aOR 0.97，95%CI 0.62-1.52，p=0.908）或 DSM（1.1%与 1.0%；aOR 0.91，95%CI 0.36-2.29，p=0.848）之间无关联。Kaplan-Meier 分析显示，出院后 30 天两组的住院再入院率无差异（3.9%与 4.1%，p=0.325）。
在接受择期 LNF 的患者中，与传统的住院术后护理相比，术后并发症和 30 天再入院率没有显著差异。应进一步考虑将 LNF 转变为门诊手术。
