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Factors associated with admission after implementation of a same-day discharge pathway in patients undergoing peroral endoscopic myotomy (POEM)

  • 2020 SAGES Oral
  • Published:
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Abstract

Background

Although peroral endoscopic myotomy (POEM) has emerged as a highly efficacious procedure in the treatment of a variety of esophageal motility disorders, currently no standard pathway for postprocedural care exists. Our study aims to report institutional outcomes in performing POEM as an outpatient procedure with same-day discharge. Additionally, we seek to determine factors associated with admission.

Methods

Demographic, perioperative, and postoperative outcome data of 115 patients who underwent POEM between June 2014 and January 2020 on a same-day discharge pathway were analyzed. Cohorts were compared using the t test, Wilcoxon rank-sum, or chi-square test. Multivariable logistic regression with a manual backward selection method was used to identify factors associated with admission.

Results

Fifty-five patients (48%) were successfully discharged same-day. The most common primary reasons for admission were delay in obtaining an esophagram (25%), intraoperative complication (13.3%), and pain (10%). There were no differences in 30-day ED visit rate (12.7% vs 15.0%, p = 0.725) or 30-day readmission rate (9.1% vs 16.7%, p = 0.373) between patients who were discharged same-day versus patients who were admitted. Patients discharged same-day had fewer intraoperative complications (1 vs 9, p = 0.017), shorter OR time (69 vs 100 min, p < 0.001), and earlier cessation of narcotic use (day 0 vs day 1, p = 0.001). On multivariable analysis, intraoperative complication (p = 0.048) was associated with overnight admission.

Conclusion

Patients did not experience additional morbidity with same-day discharge after POEM. A delay in obtaining an esophagram was the most common reason that patients were admitted and those who suffered an intraoperative complication are more likely to require admission.

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Authors and Affiliations

  1. Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, GCSI Suite B665, Evanston, IL, 60201, USA

    Mikhail Attaar, Bailey Su, Harry J. Wong, Kristine Kuchta, Woody Denham, Stephen P. Haggerty, John Linn & Michael B. Ujiki

  2. Department of Surgery, University of Chicago Medical Center, Chicago, USA

    Mikhail Attaar, Bailey Su & Harry J. Wong

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  1. Mikhail Attaar
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  2. Bailey Su
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Correspondence to Mikhail Attaar.

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Disclosures

Drs Linn, Haggerty, and Ujiki receive payment for lectures from Gore. Dr Haggerty is a paid consultant to Medtronic. Dr Ujiki is a board member for Boston Scientific, is a paid consultant for Olympus and Cook, and receives payment for lectures from Medtronic and Erbe. Drs Attaar, Denham, Su, Wong, and Kristine Kuchta have no conflicts of interest or financial ties to disclose.

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Attaar, M., Su, B., Wong, H.J. et al. Factors associated with admission after implementation of a same-day discharge pathway in patients undergoing peroral endoscopic myotomy (POEM). Surg Endosc 35, 3971–3980 (2021). https://doi.org/10.1007/s00464-020-07866-0

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  • DOI: https://doi.org/10.1007/s00464-020-07866-0

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