30-Day outcomes and opioid prescriptions following outpatient rigid endoscopic Zenker's diverticulectomy and cricopharyngeal myotomy

OBJECTIVES: To describe our institutional experience with outpatient rigid endoscopic Zenker's diverticulotomy (RE-ZD) or cricopharyngeal myotomy (RE-CPM) by comparing 1) 30-day complications rates, 2) operative technique, and 3) opioid medications prescribed for pain control. STUDY DESIGN: Retrospective cohort study. SETTINGS: Integrated health system. METHODS: A retrospective cohort study was performed on all patients who underwent RE-ZD or RE-CPM by a single surgeon from November 2015 to March 2024. Surgical techniques included the use of the endoscopic stapler or carbon dioxide (CO2) laser myotomy. Outcomes included 30-day complications and amount of opioid medication prescribed (in morphine milligram equivalents [MMEs]), which were compared between patients who had 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 outpatient and admitted groups, even among those who underwent CO2 laser myotomy (all p > 0.05). Patients admitted overnight received significantly more opioid medication (median 20 vs 0 MME), due to doses that were administered in-house (p < 0.05). CONCLUSION: Outpatient RE-ZD and RE-CPM, even with CO2 laser myotomy, is safe with the potential to reduce the amount of opioid medications administered.