A Nationwide Safety Analysis of Discharge on the First Postoperative Day After Bariatric Surgery in Selected Patients
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Enhanced recovery after surgery has led to early recovery and shorter hospital stay after laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). This study aims to assess feasibility and outcomes of postoperative day (POD) 1 discharge after LRYGB and LSG from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) 2015 dataset.
Patients who underwent elective LRYGB and LSG and were discharged on POD 1 and 2 were extracted from the MBSAQIP dataset. A 1:1 propensity score matching was performed between cases with POD 1 vs POD 2 discharge, and the 30-day outcomes of the cohorts were compared.
A total of 80,464 patients met the study criteria: 8862 LRYGB and 31,370 LSG cases, which were discharged on POD 1, and matched 1:1 with those discharged on POD 2. Within the LRYGB cohort, patients discharged on POD 2 had higher all-cause morbidity (7.5% vs 6.1%; p < 0.001) and 30-day re-intervention (2.0% vs 1.5%; p = 0.004) in comparison with patients discharged on POD 1. There were no statistical differences with respect to serious morbidity (0.5% vs 0.4%; p = 0.15), 30-day readmission (4.9% vs 4.5%; p = 0.2), and 30-day reoperation (1.3% vs 1.2%; p = 0.7). Within the LSG cohort, patients discharged on POD 2 had higher all-cause morbidity (4.2% vs 3.4%; p < 0.001), serious morbidity (0.4% vs 0.3%; p < 0.001), 30-day re-intervention (1.0% vs 0.6%; p < 0.001), and 30-day readmission (2.9% vs 2.5%; p = 0.002) in comparison with patients discharged on POD 1.
Early discharge on POD 1 may be safe in a selective group of bariatric patients without significant comorbidities.
KeywordsMorbid obesity Gastric bypass Roux-en-Y RYGB Complication, enhanced recovery, readmission, sleeve gastrectomy, bariatric
Compliance with Ethical Standards
The Institutional Review Board approved this study under exempt status, as the data were publically available in a de-identified manner.
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval Statement
For this type of study formal consent is not required.
Informed Consent Statement
This study does not require informed consent.
- 1.English WJ, DeMaria EJ, Brethauer SA, et al. American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. Surg Obes Relat Dis. 2018;14(3):259–63. https://doi.org/10.1016/j.soard.2017.12.013.
- 2.Khorgami Z, Petrosky JA, Andalib A, et al. Fast track bariatric surgery: safety of discharge on the first postoperative day after bariatric surgery. Surg Obes Relat Dis. 2017;13(2):273–80. https://doi.org/10.1016/j.soard.2016.01.034.
- 3.McCarty TM, Arnold DT, Lamont JP, et al. Optimizing outcomes in bariatric surgery. Trans . Meet Am Surg Assoc. 2005;123(NA):188–95. https://doi.org/10.1097/01.sla.0000183354.66073.4c.
- 4.Barreca M, Renzi C, Tankel J, et al. Is there a role for enhanced recovery after laparoscopic bariatric surgery? Preliminary results from a specialist obesity treatment center. Surg Obes Relat Dis. 2016;12(1):119–26. https://doi.org/10.1016/j.soard.2015.03.008.
- 5.Fares II LG, Reeder RC, Bock J, et al. 23-hour stay outcomes for laparoscopic Roux-en-Y gastric bypass in a small, teaching community hospital. Am Surg. 2008;74(12):1206–10. http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L352811657%5Cn http://vu.on.worldcat.org/atoztitles/link?sid=EMBASE&issn=00031348&id=doi:&atitle=23-Hour+stay+outcomes+for+laparoscopic+Roux-en-Y+gastric+bypass+in+a+small%2C+teaching
- 7.O’Rourke RW, Andrus J, Diggs BS, et al. Perioperative morbidity associated with bariatric surgery. Arch Surg. 2006;141(3):262–8. https://doi.org/10.1001/archsurg.141.3.262.
- 8.Livingston EH, Huerta S, Arthur D, et al. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg. 2002;236(5):576–82. https://doi.org/10.1097/01.SLA.0000033321.22614.D6.
- 9.Still CD, Wood GC, Chu X, et al. Clinical factors associated with weight loss outcomes after Roux-en-Y gastric bypass surgery. Obesity. 2014;22(3):888–94. https://doi.org/10.1002/oby.20529.
- 11.Cawley J, Sweeney MJ, Kurian M, Beane S, New York State Bariatric Surgery Workgroup. Predicting complications after bariatric surgery using obesity-related co-morbidities. Obes Surg 2007;17(11):1451–1456.Google Scholar
- 12.Haskins IN, Nowacki AS, Khorgami Z, et al. Should recent smoking be a contraindication for sleeve gastrectomy? Surg Obes Relat Dis. 2017;13(7):1130–5. https://doi.org/10.1016/j.soard.2017.02.028.
- 14.Małczak P, Pisarska M, Piotr M, et al. Enhanced recovery after bariatric surgery: systematic review and meta-analysis. Obes Surg. 2017;27(1):226–35. https://doi.org/10.1007/s11695-016-2438-z.
- 15.Howell MH, Praiss A, Podolsky D, et al. A single-center experience examining the length of stay and safety of early discharge after laparoscopic Roux-en-Y gastric bypass surgery. 2018.Google Scholar
- 16.Mahmood F, Sharples AJ, Rotundo A, et al. Factors predicting length of stay following bariatric surgery: retrospective review of a single UK tertiary centre experience. Obes Surg. 2018;28:1924–30. https://doi.org/10.1007/s11695-017-3105-8.
- 17.Dorman RB, Miller CJ, Leslie DB, et al. Risk for hospital readmission following bariatric surgery. PLoS One. 2012;7(3):e32506. https://doi.org/10.1371/journal.pone.0032506.
- 18.Saunders J, Ballantyne GH, Belsley S, et al. One-year readmission rates at a high volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and vertical banded gastroplasty-Roux-en-Y gastric bypass. Obes Surg. 2008;18(10):1233–40. https://doi.org/10.1007/s11695-008-9517-8.
- 19.Saunders JK, Ballantyne GH, Belsley S, et al. 30-day readmission rates at a high volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and vertical banded gastroplasty-Roux-en-Y gastric bypass. Obes Surg. 2007;17(9):1171–7. http://www.ncbi.nlm.nih.gov/pubmed/18074490
- 21.Blanchet MC, Gignoux B, Matussière Y, et al. Experience with an Enhanced Recovery After Surgery (ERAS) program for bariatric surgery: comparison of MGB and LSG in 374 patients. Obes Surg. 2017;27(7):1896–900. https://doi.org/10.1007/s11695-017-2694-6.
- 22.Fayezizadeh M, Petro CC, Rosen MJ, et al. Enhanced recovery after surgery pathway for abdominal wall reconstruction: pilot study and preliminary outcomes. Plast Reconstr Surg. 2014;134(4):151S–9S. https://doi.org/10.1097/PRS.0000000000000674.
- 24.Lemanu DP, Singh PP, Berridge K, et al. Randomized clinical trial of enhanced recovery versus standard care after laparoscopic sleeve gastrectomy. Br J Surg. 2013;100(4):482–9. https://doi.org/10.1002/bjs.9026.
- 25.Upplement S, Jian C, Selvage D. B Ulletin. East. 2004;39(12).Google Scholar