Day-case laparoscopic Nissen-Rossetti fundoplication (LF) has been demonstrated to be safe in small, prospective cohorts.
Dr Gronnier and colleagues compared postoperative course, functional results, quality of life, and healthcare costs in patients undergoing LF in a day-case surgical unit with same-day discharge and patients undergoing LF as an inpatient.
There were 292 consecutive patients who underwent a primary LF for symptomatic uncomplicated gastroesophageal reflux disease from 2004 to 2011 were entered into a prospective database.
From 101 same-day discharge patients, control inpatient procedures were randomly matched by age, gender, body mass index, American Society of Anesthesiologists classification, and presence of a hiatal hernia.
|Postoperative morbidity rates were 10% in day-case groups|
The researchers observed no postoperative deaths occurred and postoperative morbidity occurred in 9% of patients.
When comparing day-case and inpatient groups, postoperative morbidity rates were 10% vs 9% with median hospital stays and readmission rates of 1 vs. 4 days, and 8% vs 0%, respectively.
The team found that Gastrointestinal Quality of Life Index was significantly enhanced due to surgery, and comparable in the two groups.
The team noted that estimated direct healthcare costs per patient were 2,248 euros in the day-case group vs 6,569 euros in the inpatient group, equivalent to a cost saving of 3,921 euros.
Dr Gronnier's team concludes, "Day-case and inpatient approaches after LF give similar results in terms of postoperative mortality and morbidity, functional outcomes and quality of life, with a substantial cost saving in favor of a day-case procedure."