Feasibility of 23-hour hospitalization after laparoscopic fundoplication

Purpose: In order to reduce the costs of laparoscopic fundoplication, a pil ot program for outpatient surgery was instituted in 1995. The risks and ben efits 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 refractor y gastroesophageal reflux disease underwent laparoscopic fundoplication ove r a 21-month period in a hospital-affiliated outpatient facility. The resul ts 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 surger y. The maximum length of stay was 3 days. There were no deaths. Nineteen pa tients (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 cos t of room, operating suite, supplies, and anesthesia. Conclusion: Laparoscopic fundoplication can be performed safely in a hospit al-affiliated outpatient setting, resulting in a significant reduction in p rocedure costs.