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Enhanced recovery outcomes following per-oral pyloromyotomy (POP): a comparison of safety and cost with same-day discharge versus inpatient recovery

  • 2019 SAGES Oral
  • Published:
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Abstract

Background

While per-oral pyloromyotomy (POP) has shown promise as a novel endoscopic procedure to treat medically refractory gastroparesis, standardized care pathways are not well-defined. We aimed to compare the safety and cost of same-day discharge (SDD) after POP with inpatient stay overnight or longer.

Methods

All patients with SDD after POP between January 2016 and May 2018 were retrospectively identified from a prospectively maintained registry. Propensity scores considering gender, age, gastroparesis etiology, and American Society of Anesthesiologists (ASA) class were used to match a comparison group which stayed overnight or longer. Statistical tests included two-sample t tests for continuous variables, Fisher’s exact test for categorical variables, and paired sample t tests for within-group comparisons with repeated measures.

Results

Fifty-four patients who underwent POP with SDD during the study period were propensity-matched with 54 patients with inpatient recovery. The SDD cohort was 85.2% female with a mean age of 44.8 years and median ASA class 3. The etiology of gastroparesis was idiopathic in 53.7% (n = 29), diabetic in 29.6% (n = 16), and post-surgical in 11.1% (n = 6). Operative time was shorter in the SDD cohort (25.4 vs. 31.3 min, p = 0.02). The mean post-procedure recovery time was 4 h in patients with SDD and 29.3 h in the inpatient cohort (p < 0.001). There was a trend towards less readmissions with SDD (7.4% vs. 18.5%, p = 0.08). There was no increased risk of complications with SDD (1.9% vs. 3.7%, p = 0.57). Compared to inpatient recovery, the average total cost for the procedure, recovery, and all subsequent care within 30 days was 26.0% less with SDD (p < 0.001).

Conclusions

Following POP, patients can be safely discharged the same day with low risk of both complications and readmission. Total costs in the complete perioperative period are significantly less with SDD compared to inpatient recovery.

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Authors and Affiliations

  1. Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA

    Joshua P. Landreneau, Andrew T. Strong, Jeffrey L. Ponsky, Matthew D. Kroh, John H. Rodriguez & Kevin El-Hayek

  2. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA

    Joshua P. Landreneau, Andrew T. Strong, Jeffrey L. Ponsky, Matthew D. Kroh, John H. Rodriguez & Kevin El-Hayek

  3. Cleveland Clinic Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Chao Tu

  4. Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

    Matthew D. Kroh

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  1. Joshua P. Landreneau
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  2. Andrew T. Strong
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Correspondence to Joshua P. Landreneau.

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Disclosures

Matthew D. Kroh—Outside of the scope of this work, he serves as a consultant for Levita Magnetics and Medtronic. He has received research funding from Cook. John H. Rodriguez—Outside of the scope of this publication, he has received research funding from Pacira Pharmaceuticals and Intuitive Surgical. Joshua P. Landreneau, Andrew Strong, Jeffrey Ponsky, Chao Tu, Matthew D. Kroh, John H. Rodriguez, and Kevin El-Hayek have no conflicts of interest or financial ties to disclose.

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Landreneau, J.P., Strong, A.T., Ponsky, J.L. et al. Enhanced recovery outcomes following per-oral pyloromyotomy (POP): a comparison of safety and cost with same-day discharge versus inpatient recovery. Surg Endosc 34, 3153–3162 (2020). https://doi.org/10.1007/s00464-019-07085-2

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