BACKGROUND: Laparoscopic hiatal hernia repair is commonly performed with a 1 to 2 night hospitalization. Our aim was to compare the feasibility and short-term outcomes of same-day surgery (SDS) laparoscopic hiatal hernia repair with an opioid-based anesthesia protocol (OBAP) vs an opioid-free anesthesia protocol (OFAP). STUDY DESIGN: Outcomes and pharmacy costs of repairs with OBAP were compared with OFAP. Values were expressed as median (interquartile range) and costs as means. RESULTS: There were 244 primary laparoscopic repairs. OBAP was used in 191 of 244 (78.3%) vs OFAP in 53 of 244 (21.7%). The length of stay was 1 day (0 to 2) vs 0 days (0 to 1), p = 0.006. There was no difference between the percentage of patients requiring analgesics and dosage between the 2 groups. SDS was planned in 157 and performed in 74 of 122 (60.7%) vs 33 of 35 (94.3%), p < 0.001. The age was 56 years (45 to 63) vs 60 years (56 to 68), p = 0.025. There were more type I hiatal hernia in SDS-OBAP and more type III and IV in SDS-OFAP, p = 0.031. American Society of Anesthesiologists Physical Status was II (II–III) vs III (II–III), p = 0.045. SDS was not performed in 50 of 157 (31.8%), 48 of 122 (39.3%) vs 2 of 35 (5.7%), p < 0.001. Out of 157 planned SDS, nausea/retching were causes of transition in 19 of 122 (15.6%) vs 0 of 35 (0%), p = 0.020. Multivariable logistic regression showed the odds of SDS were 8.21 times (95% CI 3.10 to 21.71; p < 0.001) greater in OFAP compared with OBAP, adjusting for sex, age, body mass index, American Society of Anesthesiologists Physical Status, type of hiatal hernia, type of procedure, and duration of the operation. Patients with opioid medication after SDS discharge were 74 of 74 (100%) vs 22 of 33 (66.7%), p < 0.001. CONCLUSIONS: Opioid-free anesthesia increases the feasibility of SDS hiatal hernia repair with less perioperative nausea and comparable pain control and pharmacy cost.

Introduction: Fewer women than men with heart failure (HF) progress to implantation of a left ventricular assist device (LVAD) or transplant. A comprehensive, large-database analysis of women with HF is lacking. Methods: From a commercial and a national Medicare database using OPTUM® Clinformatic® Data Mart and a Medicare National Sample comprising 57,585,519 US patients, we identified 346,345 adults treated for HF during 2014-2016. Comorbidities including diabetes, coronary artery disease, hypertension, and cardiomyopathy were recorded. Patients were monitored for stroke, mechanical ventilation, heart transplant, renal insufficiency, and death through 2019 or until they were no longer enrolled. Sex and age were discerned from enrollment information. Results: Approximately equal percentages of men (51%) and women (49%) had HF. Age at HF diagnosis was similar between men and women (60 vs 58 y). Diastolic HF was more common in women than in men prior to LVAD placement (64% vs 36%) . All patients who progressed to LVAD placement had combined systolic and diastolic heart failure. Similar numbers of men and women with HF died within the follow-up period. Women received only 24% of the implanted LVADs. Age at LVAD placement was similar between men and women (61 vs 59 y). More men than women with HF and implanted LVADs had coronary artery disease and ischemic cardiomyopathy. After LVAD implantation, intracerebral bleeding and stroke were more common in women. Conclusions: In the largest database analysis to date, HF incidence, age at diagnosis, and age at LVAD placement were similar between women and men. Fewer women progressed to LVAD placement or transplantation. The prevalence of diastolic HF was significantly higher in women prior to LVAD placement. Women’s outcomes after LVAD implantation were significantly worse than men’s, especially with regard to stroke and cerebral injury. These findings support those of smaller studies.

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