Day-case versus inpatient laparoscopic fundoplication: outcomes, quality of life and cost-analysis
Day-case laparoscopic Nissen-Rossetti fundoplication (LF) has been demonstrated to be safe in small, prospective cohorts. The purpose of the study was to compare 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.
All consecutive patients in our department who underwent a primary LF for symptomatic uncomplicated gastroesophageal reflux disease from 2004 to 2011 were entered into a prospective database (n = 292). From 101 same-day discharge patients (day-case group), control inpatient procedures were randomly matched by age, gender, body mass index, American Society of Anesthesiologists classification, and presence of a hiatal hernia (inpatient group, n = 101).
No postoperative deaths occurred and postoperative morbidity occurred in 9.4 % of patients. When comparing day-case and inpatient groups, postoperative morbidity rates were 9.9 vs. 8.9 % (p = 0.81) with median hospital stays and readmission rates of 1 vs. 4 days (p < 0.001) and 7.9 vs. 0 % (p < 0.001), respectively. Gastrointestinal Quality of Life Index was significantly enhanced due to surgery (p < 0.001) and comparable in the two groups. Estimated direct healthcare costs per patient were 2,248 euros in the day-case group vs. 6,569 euros in the inpatient group (p < 0.001), equivalent to a cost saving of 3,921 euros.
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.
KeywordsLaparoscopic fundoplication Reflux Day-case surgery Functional results Quality of life Medico-economic analysis
The authors thank Dr. William B. Robb for revision of the English language content and the anesthetic team for its involvement in conducting day-case protocols.
Study conception and design: Mariette.
Acquisition of data: Boutillier, Piessen, Gronnier, Desbeaux.
Analysis and interpretation of data: Gronnier, Boutillier, Mariette.
Drafting of manuscript: Gronnier, Mariette.
Critical revision: Triboulet, Mariette.
Drs. Gronnier, Desbeaux, Piessen, Boutillier, Ruolt, Triboulet, and Mariette have no conflicts of interest or financial ties to disclose.
Conflict of interest
The authors declare no conflicts of interest.
- 10.Caisse Nationale d’Assurance Maladie des Travailleurs Salarie’s (CNMATS): common classification of medical procedures (2013). http://www.ameli.fr/fileadmin/user_upload/documents/CCAM_V31.pdf
- 12.McLemore T, Lawrence L (1997) Plan and operation of the national survey of ambulatory surgery. National Center for Health Statistics. Vital Health Stat 37:1–124Google Scholar
- 17.Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, Zernak C, Danner K, Jokela R, Pocock SJ, Trenkler S, Kredel M, Biedler A, Sessler DI, Roewer N, IMPACT Investigators (2004) A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 350:2441–2451PubMedCentralPubMedCrossRefGoogle Scholar