FEASIBILITY AND OUTCOMES OF SAME-DAY SURGERY IN PRIMARY AND REOPEARTIVE LAPAROSCOPIC HIATAL HERNIA REPAIR
Clarissa Hoffman*2, Shalin Shah2, Megan Mai2, Andre Miller3, Farzaneh Banki1
1Cardiothoracic and Vascular Surgery, University of Texas Health Science Center, Memorial Hermann Southeast Esophageal Disease Center, Houston, TX; 2The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, TX; 3Memorial Hermann Health System, Houston, TX
Objective: to assess the feasibility and outcomes of Same-day Surgery (SDS) in primary and reoperative laparoscopic hiatal hernia repairs. Methods: Retrospective review. SDS was planned in elective procedures/ASA II-III. Opioid-Based Anesthesia Protocol (OBAP) was replaced by Opioid-Free Anesthesia Protocol (OFAP). Outcomes: length of stay, transition from SDS to observation (OBS)/inpatient (INP)/postoperative ER visits/readmissions. Values are median (IQR). Results: From 04/13/2017 to 09/29/2022 there were 525 hiatal hernia repairs in 498 patients, primary: 428/525 (81.5%), reoperative: 97/525 (25 had > 1 operation). Primary procedures were laparoscopic. Reoperative group, laparoscopic: 90/97 (92.8%), open Roux-En-Y: 7/97 (7.2%). Primary group, planned as SDS: 314/428 (73.4%), planned and performed as SDS: 246/314 (78.3%) vs. planned and not performed as SDS: 68/314 (21.7%). There was no difference in age/sex/BMI/ASA/type of hernia between 2 groups. Hernia size: 5.0 cm (4.0-6.0) vs. 6.0 (4.0-8.5), p=0.002. Operative time: 99.0 min (83.0-116.0) vs. 106.0 (89.0-122.0), p=0.020. The most common cause of transition from SDS to OBS/INP: patient preference in 30/68 (44.1%). Reoperative laparoscopic group, planned as SDS: 51/90 (56.7%), planned and performed as SDS: 27/51 (52.9%) vs. planned and not performed as SDS: 24/51 (47.1%). There was no difference in age, sex, BMI, ASA, hernia size and type, and operative time between 2 groups. The most common cause of transition from SDS to OBS/INP: patient preference in 16/24 (66.7%). Primary planned and performed as SDS with OBAP: 77/314 (24.5%) vs. planned and performed as SDS with OFAP: 169/314 (53.8%), p< 0.001. Reoperative planned and performed as SDS with OBAP: 2/51 (3.9%) vs. planned and performed as SDS with OFAP: 25/51 (49.0%), p< 0.001. Primary planned and performed as SDS with Toupet: 89/314 (28.3%) vs. planned and performed as SDS with fundopexy: 140/314 (44.6%), p< 0.001. Reoperative planned and performed as SDS with Toupet: 2/51 (3.9%) vs. planned and performed as SDS with fundopexy: 24/51 (47.1%), p< 0.001. Primary, ER visit after SDS: 39/246 (15.9%), readmissions after SDS: 26/246 (10.6%). Reoperative, ER visit after SDS: 3/27 (11.1%), readmissions after SDS: 3/27 (11.1%). Multivariable regression analysis: OFAP was the positive predictor of SDS as compared to OBAP (OR 7.4 [95%CI: 2.9, 18.8]). Negative predictors of SDS: type II/III hiatal hernia compared to I (OR 0.28 [95% CI: 0.14, 0.58]), ASA III compared to II (OR 0.47 [95% CI: 0.25, 0.88]), and duration of operation (OR 0.98 [0.97, 0.99]). Conclusion: Laparoscopic hiatal hernia repair can be performed as SDS in the majority of primary and reoperative procedures with good outcomes and low postoperative ER visits and readmissions. OFAP increases the feasibility of SDS hiatal hernia repair.
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