Outcomes of Same-Day Discharge Following Robotic Hiatal Hernia Repair: A Comparative Study.
Academic Article
Overview
abstract
BACKGROUND: With the rising use of minimally invasive techniques and recovery protocols, hiatal hernia repair is increasingly performed with a same-day discharge (SDD) approach. This study aims to identify factors affecting patient selection for SDD at a tertiary center and compare the outcomes of SDD with extended observation stay (EOS) after robotic hiatal hernia repair. METHODS: We retrospectively reviewed patients who underwent robotic hiatal hernia repair from January 2012 to April 2024. SDD patients were those managed in ambulatory care and discharged within 12hours of admission. We compared perioperative characteristics and postoperative outcomes, including emergency room (ER) returns and readmissions. Multivariate logistic regression identified risk factors for ER returns and 30-day readmission. RESULTS: Among 740 included patients, 464 were EOS and 276 were SDD. There was a growing trend toward SDD. EOS patients were generally older (p<0.001), had higher comorbidity rates (diabetes [p=0.006], hypertension [p=0.034], and pulmonary disease [p=0.013]), more paraesophageal hernia (p=0.002), and presented with more severe dysphagia (p=0.019) and elevated ASA scores (p<0.001). They also underwent more revisional surgeries (p<0.001), Collis procedures (p<0.001), relaxing incisions (p<0.001), and Nissen fundoplications (p=0.028), while SDD patients more frequently received magnetic sphincter augmentation (p=0.007). Most EOS patients had longer operative duration (p=0.001), and were evening/night cases (p=0.002), with an average hospital stay of 26.8hours (IQR 20.8-32.0) compared to 9.0hours (IQR 8.0-10.0) for SDD patients (p<0.001). However, postoperative outcomes, including ER returns, readmissions, GERD symptoms, and dysphagia, were comparable. Multivariate analysis revealed that higher ASA score (OR 1.8, CI 1.1-3.0, p=0.037) and paraesophageal hernia (OR 2.2, CI 1.2-4.1, p=0.011) were associated with a higher ER returns, while Magnetic sphincter augmentation compared to Toupet fundoplication was linked to a lower ER return rate (OR 0.2, CI 0.1-0.9, p=0.021). Diabetes (OR 3.1, CI 1.5-6.0, p=0.002) and paraesophageal hernia (OR 2.2, CI 1.2-4.4, p=0.016) both increased the odds of 30-day readmission. CONCLUSION: SDD following robotic hiatal hernia repair is safe and feasible, with outcomes similar to EOS when patients are appropriately selected. Higher ASA score, diabetes, paraesophageal hernia, and Toupet fundoplication, compared to Magnetic sphincter augmentation, are associated with increased ER returns and readmissions, highlighting the necessity for individualized patient selection. Optimizing perioperative and postoperative care can further improve SDD after hiatal hernia repair.
