title: Day-case versus inpatient laparoscopic fundoplication: outcomes, quality of life and cost-analysis.
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.
authors: Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Centre Hospitalier Régional Universitaire, Place de Verdun, 59037, Lille cedex, France, caroline.gronnier@hotmail.fr.
authors: C
authors: C
authors: Gronnier
authors: A
authors: A
authors: Desbeaux
authors: G
authors: G
authors: Piessen
authors: J
authors: J
authors: Boutillier
authors: N
authors: N
authors: Ruolt
authors: J P
authors: JP
authors: Triboulet
authors: C
authors: C
authors: Mariette
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000191:economics*; D016022:Case-Control Studies; D017046:Cost Savings; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005602:France; D018662:Fundoplication / Q000191:economics* / Q000379:methods; D005764:Gastroesophageal Reflux / Q000601:surgery; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D012086:Reoperation / Q000706:statistics & numerical data; D055815:Young Adult