Surgical Endoscopy

, Volume 28, Issue 7, pp 2159–2166 | Cite as

Day-case versus inpatient laparoscopic fundoplication: outcomes, quality of life and cost-analysis

  • C. Gronnier
  • A. Desbeaux
  • G. Piessen
  • J. Boutillier
  • N. Ruolt
  • J. P. Triboulet
  • C. Mariette
Article

Abstract

Background

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.

Methods

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).

Results

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.

Conclusions

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.

Keywords

Laparoscopic fundoplication Reflux Day-case surgery Functional results Quality of life Medico-economic analysis 

Notes

Acknowledgments

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.

Authors contributions

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.

Disclosures

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.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • C. Gronnier
    • 1
    • 2
    • 3
    • 4
  • A. Desbeaux
    • 1
    • 2
  • G. Piessen
    • 1
    • 2
    • 3
    • 4
  • J. Boutillier
    • 1
    • 2
    • 3
  • N. Ruolt
    • 1
    • 2
  • J. P. Triboulet
    • 1
    • 2
    • 3
  • C. Mariette
    • 1
    • 2
    • 3
    • 4
  1. 1.Department of Digestive and Oncological Surgery, University Hospital Claude HuriezCentre Hospitalier Régional UniversitaireLille cedexFrance
  2. 2.Ambulatory Department, University Hospital Claude HuriezCentre Hospitalier Régional UniversitaireLille cedexFrance
  3. 3.University Lille Nord de FranceLille cedexFrance
  4. 4.Inserm UMR 837, Team 5 “Mucins, Epithelial Differentiation and Carcinogenesis”JPARCLille cedexFrance

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