• James D Hannon, Lindsay L Warner, Thomas M Stewart, Todd M Kor, Shanda H Blackmon, Michael J Brown, and Arun Subramanian.
• Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN. Electronic address: hannon.james@mayo.edu.
• J. Cardiothorac. Vasc. Anesth. 2020 Jul 1; 34 (7): 1853-1857.

ObjectiveThe perioperative course of patients undergoing laparoscopic Nissen fundoplication (LNF) was reviewed to determine whether the use of a new treatment protocol consisting of total intravenous anesthesia (TIVA) plus triple antiemetic therapy was associated with shorter hospital length of stay (HLOS).DesignRetrospective cohort.SettingSingle academic center.ParticipantsThe study comprised 448 patients. Fifty-four patients undergoing LNF who received TIVA were compared with 394 who received standard inhalational anesthesia (non-TIVA) between January 2010 and June 2017.InterventionsPatients who received TIVA were compared with those who received non-TIVA.Measurements And Main ResultsIn multivariate analysis, TIVA was significantly associated with reduced HLOS (odds ratio 2.91, 95% confidence interval 1.47-5.78) and a 7.8% reduction in cost of care (p < 0.01). Female sex, length of surgery, and older age all were negatively associated with length of stay. The association between the use of TIVA and reduced HLOS and institutional cost was compared using univariate and multivariate analyses.ConclusionsThe use of TIVA in patients undergoing uncomplicated LNF shortens HLOS and is associated with reduced cost of care. This study illustrates that communication among surgeons and anesthesiologists results in improved patient care.Copyright © 2020 Elsevier Inc. All rights reserved.

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