Same-day home recovery for benign foregut surgery

1. A program to promote same-day home recovery (SHR) for patients after benign foregut surgery improved SHR rates from 11.5% to 72.6% gradually over 3 years.

Evidence Rating Level: 2 (Good)

Same-day home recovery (SHR) has become a care standard for many surgical procedures, including minimally invasive general surgery and orthopedic surgery. As such, a benign foregut surgery group based out of Northern California developed a program to increase the rates of SHR for these procedures. This current study evaluates the rates of SHR and adverse events before and after this implementation. The SHR program was created by foregut surgeons with patient education at the centre, including patient-family involvement by outlining how to prepare for surgery, expectations for the patient’s condition after surgery, and how to promote recovery at home. Other aspects included promoting early oral intake, early physical activity, and an opioid-sparing analgesic plan post-operatively. In total, 1248 patients underwent the 3 most common benign foregut surgery procedures (hiatal hernia repair, fundoplication, and Heller myotomy) in the study period, with 558 occurring prior to the SHR program, and 690 occurring after. The results showed that the SHR rate was 11.5% in 2018 prior to the program and increased gradually to 26.9% in 2019, 49.3% in 2020, and 72.6% in 2021 (p < 0.001). Additionally, there were comparable rates of mortality (1 death in both groups), postoperative ED visits at 7 and 30 days, hospital readmissions, and reoperations. Overall, this study showed that an SHR program centred on patient education and early recovery increased the rate of SHR amongst benign foregut surgery patients, without differences in adverse events or complications.

Click to read the study in JAMA Surgery

Image: PD

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