Day-case laparoscopic Nissen fundoplication.
BACKGROUND
For day-case laparoscopic surgery to be successful, patient selection is of the utmost importance. This study aimed to assess the feasibility of day-case laparoscopic Nissen fundoplication and to identify factors that may lead to readmission and overstay.


METHODS
A retrospective review of all patients who underwent day-case laparoscopic Nissen fundoplication over a 4-year period (2006 through 2010) was undertaken. Patient age, social circumstances, and other demographics were recorded as well as any comorbidities and ASA score. The primary endpoint  measured was rate of readmission and overstay.


RESULTS
A total of 72 patients fulfilled the inclusion criteria for day-case surgery. Five patients (6.94%) required admission immediately following the procedure, ie, overstayed or were readmitted. The rates were 1.38% (P=.05, CI  95%) for readmission and 5.55% (P=.05, CI 95%) for overstay. Six (8.33%) patients were classified as ASA III, and 3 (50%) were readmitted or overstayed.


CONCLUSIONS
Day-case laparoscopic Nissen fundoplication is a feasible, safe option. The authors conclude that ASA score of III  and increasing age correlate with an increasing incidence of overstay and readmission. Therefore, we would recommend the use of integrated pathways and advanced planning to reduce these rates.
Department of Surgery, Naas General Hospital, Naas, Co. Kildare, Ireland. tahirkheli73@gmail.com
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Khan
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Stephens
D000367:Age Factors; D000556:Ambulatory Surgical Procedures; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data