Factors associated with admission after implementation of a same-day discharge pathway in patients undergoing peroral endoscopic myotomy (POEM)

• Published in: Surgical endoscopy Vol. 35; no. 7; pp. 3971 - 3980
• Main Authors: Attaar, Mikhail, Su, Bailey, Wong, Harry J., Kuchta, Kristine, Denham, Woody, Haggerty, Stephen P., Linn, John, Ujiki, Michael B.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.07.2021; Springer Nature B.V
• Subjects: 2020 SAGES Oral; Abdominal Surgery; Anesthesia; Dysphagia; Endoscopy; Esophagus; Gastroenterology; Gynecology; Hepatology; Laparoscopy; Medicine; Medicine & Public Health; Motility; Pain; Patient satisfaction; Postoperative period; Proctology; Statistical analysis; Surgery; Achalasia; Esophageal; Same-day discharge; Peroral endoscopic myotomy (POEM)
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-020-07866-0

Background Although peroral endoscopic myotomy (POEM) has emerged as a highly efficacious procedure in the treatment of a variety of esophageal motility disorders, currently no standard pathway for postprocedural care exists. Our study aims to report institutional outcomes in performing POEM as an outpatient procedure with same-day discharge. Additionally, we seek to determine factors associated with admission. Methods Demographic, perioperative, and postoperative outcome data of 115 patients who underwent POEM between June 2014 and January 2020 on a same-day discharge pathway were analyzed. Cohorts were compared using the t test, Wilcoxon rank-sum, or chi-square test. Multivariable logistic regression with a manual backward selection method was used to identify factors associated with admission. Results Fifty-five patients (48%) were successfully discharged same-day. The most common primary reasons for admission were delay in obtaining an esophagram (25%), intraoperative complication (13.3%), and pain (10%). There were no differences in 30-day ED visit rate (12.7% vs 15.0%, p  = 0.725) or 30-day readmission rate (9.1% vs 16.7%, p  = 0.373) between patients who were discharged same-day versus patients who were admitted. Patients discharged same-day had fewer intraoperative complications (1 vs 9, p  = 0.017), shorter OR time (69 vs 100 min, p  < 0.001), and earlier cessation of narcotic use (day 0 vs day 1, p  = 0.001). On multivariable analysis, intraoperative complication ( p  = 0.048) was associated with overnight admission. Conclusion Patients did not experience additional morbidity with same-day discharge after POEM. A delay in obtaining an esophagram was the most common reason that patients were admitted and those who suffered an intraoperative complication are more likely to require admission.