OGBN P17 Day-Case Fundoplications: a Coastal DGH’s Transition

Abstract

Abstract Background Torbay Hospital has a well-established day surgery unit, treating over 9,000 patients a year. Day-case laparoscopic fundoplications (LF) are increasingly common, and equally safe in comparison to inpatient procedures. The purpose of this study was to analyse the difference between day-case and inpatients, to determine reasons for stay, and subsequently facilitate more day-cases in Torbay Hospital. Methods This is a retrospective study using electronic records to analyse admission, surgery and 30-days recovery. Patients were identified between 1st January 2020 and 1st April 2023 by searching the following OPCS 4.10 codes in operation notes: G231 – G234, G241 - G243 & G245 (hiatus/oesophageal/diaphragmatic hernia repair). This identified 96 procedures, 1 of which was immediately excluded as incorrectly identified. Parameters examined were as follows: indication for surgery, elective or emergency, length of stay post operatively, reason for stay, plan for daycase or inpatient stay, readmission within 30 days and reason, and hiatus hernia grade. Results 19 of 95 procedures were day-cases: 5% of cases in 2020, 2021 22%, 2022 19% and 83% so far in 2023. All day-cases were elective, whilst 9% of inpatients were emergency. Indications for day-cases were reflux (79%), atypical symptoms (16%) and stricture (5%). Inpatient indications were: reflux (39%), gastric volvulus (23%), hiatus hernia (12%), atypical (7%) and other (19%). Average Hill Classification of hiatus hernia was type-I in day-case and type-III in inpatients. 4 (21.1%) of day-case patients were readmitted (30 days), 13 (17.3%) of inpatients. The difference was 3.8% (95%CI -12.72 to 24.12), SE for percentage difference 9.2, p0.69. Conclusions The majority of LF at Torbay Hospital have been inpatient, although day-cases are increasing. Successful day-cases were always elective, of less severe hiatus hernias, and more commonly for symptomatic reflux as opposed to other pathology. There is no significant difference in the rates of readmission between the two groups. These indicate a pattern to identify future day-case LF and improve our service.