30-Day Outcomes and Opioid Prescriptions Following Outpatient Rigid Endoscopic Zenker’s Diverticulectomy and Cricopharyngeal Myotomy

Introduction: Outpatient surgical procedures are associated with increased patient satisfaction, reduced healthcare costs, and fewer hospital-related infections. There is potential for the endoscopic surgical treatment of Zenker’s diverticulum (ZD) or cricopharyngeal myotomy (RE-CPM) to evolve into an outpatient procedure in select patients. Our retrospective study aims to assess the feasibility of same-day discharge of RE-ZD or RE-CPM by comparing 1) 30-day complication rates and 2) opioid medications prescribed for pain control.

Methods: A retrospective cohort study was performed on all patients who underwent RE-ZD or RE-CPM from November 2015 to March 2024 within an integrated equal-access health system. Data were abstracted for patient demographic information, clinical history, procedural characteristics, length of hospital stay, opioid medications administered during hospitalization and prescribed on discharge, as well as 30-day follow up. Outcomes of interest included 30-day complications and total amount of opioid medication prescribed (in morphine milligram equivalents [MMEs]), and were compared between patients with same-day discharge and those admitted for observation.

Results: 103 patients (mean age 75.4 + 10.4 years, 53.4% men, 89.3% white) underwent RE-ZD or RE-CPM with a median length of stay of 1 day (range 0-8). 45 (43.7%) patients had same-day discharges. Intraoperative complications included bleeding and perforation (each n=1, 1.0%), whereas 30-day complications included subcutaneous emphysema, salivary leak/fistula, and persistent dysphagia with residual CP bar (each n=1, 1.0%). There were no significant differences in patient characteristics, complications, or discharge opioid prescriptions between the same-day discharge and admitted groups (all p > 0.05). However, patients admitted overnight received significantly more opioid medication in total (median 20 MME vs 0 MEE), due to doses that were administered in-house (p < 0.05).

Conclusions: Same-day discharge from RE-ZD and RE-CPM is safe and feasible, with the potential to reduce the amount of opioid medications administered.