INTRODUCTION Post-operative non-urgent hospital visits (NUR-HV) are an important quality target for reducing unnecessary healthcare utilization. The primary objective of this study was to characterize 90-day post-operative hospital use and determine independent predictors for NUR-HV and urgent (UR)-HV after elective laparoscopic paraesophageal hernia repair (LPEHR) and Nissen Fundoplication (LNF). METHODS Five hundred and sixty-two primary LPEHR and LNF patients were retrospectively reviewed at a single institution. Ninety-day NUR-HV and UR-HV were compared to patients without post-operative HV using baseline medical and demographic data, preoperative work-up (manometry, pH testing, disease-specific quality of life and symptom scale scores (GERSS), and hospital course. Multiple logistic models were created using univariate associations (p < 0.1) to model independent predictors of NUR-HV and UR-HV. RESULTS NUR-HV accounted for 52% (n = 30) of all 90-HV, while the remaining were UR-HV (n = 28, 48.3%). Compared to controls, NUR-HV were younger (51.2 ± 16.8 years vs. 57.6 ± 15.2, p = 0.05), had a lower baseline BMI (28.2 ± 6.4 vs. 31.3 ± 5.4, p = 0.003) and ASA scores (p = 0.02), presented with higher GERSS (46 (28-60) vs. 35 (19-48), p = 0.02) and dysphagia scores (3 (1-5) vs. 2 (0-4), p = 0.02), were associated with LNF (77.7% vs. 54.6%, p = 0.02), and experienced more post-operative dysphagia (13.3% vs. 4.6%, p = 0.06). UR-HV were older (64.0 ± 13.2 vs. 57.6 ± 15.2, p = 0.03), associated with LPEHR (67.9% vs. 45.4%, p = 0.02), longer hospital stay (2 (1-3) vs. 1 (1-2), p = 0.003), and increased overall (39.3% vs. 15.1%, p = 0.001) and urgent complications (34.6% vs. 8.3%, p < 0.005). Positive predictors of NUR-HV included ASA score < 3 (OR 4.4, p = 0.02), increasing GERSS (1.04, p = 0.01), and reduced peristalsis (OR 4.7, p = 0.01), while UR-HV were independently predicted by urgent complications (5.0, p < 0.00005). CONCLUSIONS NUR-HV accounted for half of post-operative visits following LNF/LPEHR and were predicted by distinct characteristics compared to UR-HV. This stratification provides novel insight that will guide both preoperative counseling and post-operative quality initiatives.

中文翻译：

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选择性微创前肠手术后医院利用的模式。

简介术后非紧急医院就诊（NUR-HV）是减少不必要的医疗保健使用的重要质量目标。这项研究的主要目的是表征术后90天的医院使用情况，并确定选择性腹腔镜食管旁疝修补术（LPEHR）和尼森胃底折叠术（LNF）后NUR-HV和紧急（UR）-HV的独立预测因子。方法回顾性回顾了562例原发性LPEHR和LNF患者。使用基线医学和人口统计学数据，术前检查（测压，pH测试，特定疾病的生活质量和症状量表评分（GERSS）），将90天的NUR-HV和UR-HV与没有术后HV的患者进行比较。和医院课程。使用单变量关联创建了多个逻辑模型（p <0。1）对NUR-HV和UR-HV的独立预测变量建模。结果NUR-HV占所有90-HV的52％（n = 30），其余为UR-HV（n = 28，48.3％）。与对照组相比，NUR-HV年轻（51.2±16.8岁vs. 57.6±15.2，p = 0.05），基线BMI较低（28.2±6.4 vs. 31.3±5.4，p = 0.003）和ASA评分（p = 0.02），更高的GERSS（46（28-60）vs.35（19-48），p = 0.02）和吞咽困难评分（3（1-5）vs 2（0-4），p = 0.02） ，与LNF相关（77.7％vs. 54.6％，p = 0.02），并且术后吞咽困难更多（13.3％vs. 4.6％，p = 0.06）。UR-HV年龄较大（64.0±13.2 vs. 57.6±15.2，p = 0.03），与LPEHR相关（67.9％vs. 45.4％，p = 0.02），住院时间更长（2（1-3）vs. 1（ 1-2），p = 0.003），总体增加（39.3％vs. 15.1％，p = 0.001）和紧急并发症（34.6％vs. 8.3％，p <0.005）。NUR-HV的阳性预测指标包括ASA评分<3（OR 4.4，p = 0.02），GERSS增加（1.04，p = 0.01）和蠕动降低（OR 4.7，p = 0.01），而UR-HV由紧急并发症（5.0，p <0.00005）。结论NUR-HV占LNF / LPEHR术后访视的一半，与UR-HV相比，其独特特征可以预测。这种分层提供了新颖的见解，将指导术前咨询和术后质量倡议。结论NUR-HV占LNF / LPEHR术后访视的一半，与UR-HV相比，其独特特征可以预测。这种分层提供了新颖的见解，将指导术前咨询和术后质量倡议。结论NUR-HV占LNF / LPEHR术后访视的一半，与UR-HV相比，其独特特征可以预测。这种分层提供了新颖的见解，将指导术前咨询和术后质量倡议。