Outcomes of same-day discharge after robotic hiatal hernia repair: a comparative study.

Overview

abstract

BACKGROUND: With the increasing use of minimally invasive techniques and recovery protocols, hiatal hernia repair is increasingly performed with a same-day discharge (SDD) approach. This study aimed 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: This was a retrospective review of patients who underwent robotic hiatal hernia repair from January 2012 to April 2024. Patients who had SDD were those managed in ambulatory care and discharged within 12 h of admission. This study compared perioperative characteristics and postoperative outcomes, including emergency department (ED) returns and readmissions. Multivariate logistic regression identified risk factors for ED returns and 30-day readmission. RESULTS: Among 740 included patients, 464 had EOS, and 276 had SDD. There was a growing trend toward SDD. Patients who had EOS were generally older (P <.001); had higher comorbidity rates (diabetes mellitus [P =.006], hypertension [P =.034], and pulmonary disease [P =.013]); had more paraesophageal hernias (P =.002); and presented with more severe dysphagia (P =.019) and elevated American Society of Anesthesiologists (ASA) scores (P <.001). In addition, patients who had EOS underwent more revisional surgical procedures (P <.001), Collis procedures (P <.001), relaxing incisions (P <.001), and Nissen fundoplications (P =.028), whereas patients who had SDD more frequently received magnetic sphincter augmentation (MSA; P =.007). Most patients who had EOS had longer operative duration (P =.001) and were evening/night cases (P =.002), with an average hospital stay of 26.8 h (IQR, 20.8-32.0) compared with 9.0 h (IQR, 8.0-10.0) for patients who had SDD (P <.001). However, postoperative outcomes, including ED returns, readmissions, gastroesophageal reflux disease symptoms, and dysphagia, were comparable. Multivariate analysis revealed that a higher ASA score (odds ratio [OR], 1.8 [95% CI, 1.1-3.0]; P =.037) and paraesophageal hernia (OR, 2.2 [95% CI, 1.2-4.1]; P =.011) were associated with a higher ED returns and that MSA was associated with a lower ED return rate than Toupet fundoplication (OR, 0.2 [95% CI, 0.1-0.9]; P =.021). Diabetes mellitus (OR, 3.1 [95% CI, 1.5-6.0]; P =.002) and paraesophageal hernia (OR, 2.2 [95% CI, 1.2-4.4]; P =.016) increased the odds of 30-day readmission. CONCLUSION: SDD after robotic hiatal hernia repair is safe and feasible, with outcomes similar to those of EOS when patients are appropriately selected. Higher ASA score, diabetes mellitus, paraesophageal hernia, and Toupet fundoplication are associated with increased ED returns and readmissions compared with MSA, highlighting the necessity for individualized patient selection. Optimizing perioperative and postoperative care can further improve SDD after hiatal hernia repair.