Feasibility of 23-hour hospitalization after laparoscopic fundoplication

Purpose: In order to reduce the costs of laparoscopic fundoplication, a pilot program for outpatient surgery was instituted in 1995. The risks and benefits of reducing postoperative hospitalization to less than or equal to 23 hours were assessed. Patients and Methods: Patients in ASA grade I or II (N = 22) with refractory gastroesophageal reflux disease underwent laparoscopic fundoplication over a 21-month period in a hospital-affiliated outpatient facility. The results were compared with those of a similar group of 16 patients whose surgery was performed on an inpatient basis. Results: Seventeen patients (77%) were discharged within 23 hours of surgery. The maximum length of stay was 3 days. There were no deaths. Nineteen patients (86%) reported excellent results. The average facility cost declined from $7169 for the inpatient group to $4588 for patients on operated under the outpatient protocol. The decrease resulted from a reduction in the cost of room, operating suite, supplies, and anesthesia. Conclusion: Laparoscopic fundoplication can be performed safely in a hospital-affiliated outpatient setting, resulting in a significant reduction in procedure costs.