Skip to main content
SpringerLink
Log in

Predictors of Increased Length of Hospital Stay Following Laparoscopic Sleeve Gastrectomy from the National Surgical Quality Improvement Program

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Laparoscopic sleeve gastrectomy is the most commonly performed bariatric procedure in the USA. Identifying preoperative risk factors for prolonged postoperative hospital stay will help appropriately select patients for fast-track protocols and avoid costly readmissions. To date, there has been no large national database analysis of risk factors for prolonged length of stay following laparoscopic sleeve gastrectomy.

Methods

Laparoscopic sleeve gastrectomy procedures reported to the American College of Surgeons National Surgical Quality Improvement Program between 2009 and 2012 were reviewed. Open procedures and revisional procedures were excluded. Baseline patient characteristics and preoperative lab values were reviewed. Univariate analysis was conducted to identify patient factors that predicted prolonged hospitalization (defined as ≥ 3 days). Multivariate logistic regression was used to identify factor associated with prolonged length of stay.

Results

We identified 11,430 patients who underwent laparoscopic sleeve gastrectomy. The median length of stay was 2 days and 18.4% required hospitalization ≥ 3 days. Multivariate analysis revealed that female sex, age greater than 65, body mass index greater than 50, chronic obstructive pulmonary disease, hypertension, renal insufficiency, anemia, and prolonged operative time were significantly associated with prolonged hospital stay.

Conclusions

Preoperative patient characteristics as well as operative details predict prolonged length of stay following laparoscopic sleeve gastrectomy. As the utilization of fast-track protocols in bariatric surgery programs expands, these data may be used to assist in the selection of patients who may be inappropriate for rapid discharge from the hospital after sleeve gastrectomy as well as guide medical optimization strategies preoperatively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. American Society for Metabolic and Bariatric Surgery. Estimate of Bariatric Surgery Numbers, 2011-2015. https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. Accessed May 15, 2017

  2. Khorgami Z, Shoar S, Andalib A, Aminian A, Brethauer SA, Schauer PR. Trends in utilization of bariatric surgery, 2010-2014: sleeve gastrectomy dominates. Surg Obes Relat Dis. 2017. https://doi.org/10.1016/j.soard.2017.01.031.

  3. Kehagias I, Karamanakos SN, Argentou M, Kalfarentzos F. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI 50 kg/m2. Obes Surg 2011;21:1650–6.

    Article  PubMed  Google Scholar 

  4. Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg 2008;247:401–7.

    Article  PubMed  Google Scholar 

  5. Lancaster RT, Hutter MM. Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc 2008; 22:2554.

    Article  PubMed  Google Scholar 

  6. Longitudinal Assessment of Bariatric Surgery (LABS) Consortium, Flum DR, Belle SH, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med 2009; 361:445.

    Article  Google Scholar 

  7. Stenberg E, Szabo E, Agren G, et al. Early complications after laparoscopic gastric bypass surgery: results from the Scandinavian Obesity Surgery Registry. Ann Surg 2014; 260:1040.

    Article  PubMed  Google Scholar 

  8. ASMBS Clinical Issues Committee Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis 2012;8(3):e21–6.

    Article  Google Scholar 

  9. Morton JM et al Is ambulatory laparoscopic Roux-en-Y gastric bypass associated with higher adverse events? Ann Surg 2014 259(2):286–292

    Article  PubMed  Google Scholar 

  10. Lois AW et al The relationship between duration of stay and readmissions in patients undergoing bariatric surgery. Surgery 2015 158(2):501–50

    Article  PubMed  PubMed Central  Google Scholar 

  11. 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;100:482–9.

    Article  CAS  PubMed  Google Scholar 

  12. Khorgami Z, Petrosky JA, Andalib A, Aminian A, Schauer PR, Brethauer SA. Fast track bariatric surgery: safety of discharge on the first postoperative day after bariatric surgery. Surg Obes Relat Dis 2017;13(2):273–80.

  13. Awad S, Carter S, Purkayastha S, Hakky S, Moorthy K, Cousins J, Ahmed AR. Enhanced recovery after bariatric surgery (ERABS): clinical outcomes from a tertiary referral bariatric centre. Obes Surg. 2014 24(5):753–8.

    Article  PubMed  Google Scholar 

  14. Carter J, Elliott S, Kaplan J, Lin M, Posselt A, Rogers S. Predictors of hospital stay following laparoscopic gastric bypass: analysis of 9,593 patients from the National Surgical Quality Improvement Program. Surg Obes Relat Dis 2015;11(2):288–94.

    Article  PubMed  Google Scholar 

  15. Giordano S, Victorzon M. The impact of preoperative weight loss before laparoscopic gastric bypass. Obes Surg. 2014 24(5):669–74.

    Article  PubMed  Google Scholar 

  16. Anderin C, Gustafsson UO, Heijbel N, Thorell A. Weight loss before bariatric surgery and postoperative complications: data from the Scandinavian Obesity Registry (SOReg). Ann Surg. 2015 261(5):909–13

    Article  PubMed  Google Scholar 

  17. Berger ER, Clements RH, Morton JM, Huffman KM, Wolfe BM, Nguyen NT, Ko CY, Hutter MM. The Impact of Different Surgical Techniques on Outcomes in Laparoscopic Sleeve Gastrectomies: The First Report from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Ann Surg. 2016 264(3):464–73

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Rush University Medical Center, 1750 W Harrison St, Chicago, IL, 60612, USA

    Reid Fletcher, Rebecca Deal, John Kubasiak, Alfonso Torquati & Philip Omotosho

Authors
  1. Reid Fletcher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rebecca Deal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Kubasiak
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alfonso Torquati
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Philip Omotosho
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors listed above made substantial contributions to the conception and design of this study, have revised its intellectual content, and have approved of the final submitted version.

Corresponding author

Correspondence to Reid Fletcher.

Ethics declarations

This study received exempted status by the Rush University Medical Center IRB.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fletcher, R., Deal, R., Kubasiak, J. et al. Predictors of Increased Length of Hospital Stay Following Laparoscopic Sleeve Gastrectomy from the National Surgical Quality Improvement Program. J Gastrointest Surg 22, 274–278 (2018). https://doi.org/10.1007/s11605-017-3642-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-017-3642-4

Keywords

Search

Navigation