Advertisement

Modifiable Factors to Prevent Prolonged Length of Stay after Sleeve Gastrectomy

  • Max Meneveau
  • J. Hunter Mehaffey
  • Peter D. Adams
  • Florence E. Turrentine
  • Bruce Schirmer
  • Peter T. HallowellEmail author
Original Contributions
  • 19 Downloads

Abstract

Background

Early discharge after laparoscopic sleeve gastrectomy (SG) is common and safe, but two-thirds of patients are still hospitalized longer than 1 day. The purpose of this study was to evaluate factors associated with early discharge at a single institution with intention to discharge on postoperative day 1.

Methods

Retrospective review of preoperative, intraoperative, and postoperative factors was performed for all patients undergoing SG at an academic hospital between 2010 and 2016. The primary outcome measure was length of stay (LOS). Multivariate logistic regression was used to identify independent predictors of prolonged LOS.

Results

A total of 367 patients undergoing SG were included. Two hundred eighty-seven (78%) were women and 294 (80%) were Caucasian. Mean age was 45.5 years and mean body mass index (BMI) was 48.7 kg/m2. One hundred twenty-three patients (33.5%) had a LOS ≤ 1 day. Compared to patients staying ≥ 2 days, early discharge patients had significantly lower BMI, creatinine, and American Society of Anesthesiologists class, were more likely to be White, married, have private insurance, and were more likely to have a morning start and no postoperative upper gastrointestinal (UGI) swallow study. Regression analysis demonstrated several independent predictors of prolonged LOS including institutional experience (OR 0.5, p < 0.001), case start time (OR 0.6, p = 0.04), and routine UGI swallow (OR 8.8, p < 0.0001) postoperatively.

Conclusions

LOS after SG is affected by multiple factors, including patient health, socioeconomic status, case order, and postoperative management. Optimization of these may allow for improvement in preoperative education and streamlined postoperative pathways, resulting in reduced LOS.

Keywords

Sleeve gastrectomy Length of stay Resource utilization Bariatric pathway 

Notes

Funding

The National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number T32HL007849 supported research reported in this publication.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

The study was retrospective. This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study formal consent is not required.

Informed Consent

Does not apply. Exempt from IRB review with waiver of consent. IRB#1880.

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

References

  1. 1.
    Smith KB, Smith MS. Obesity statistics. Primary care: clinics in office practice. /10;431.Google Scholar
  2. 2.
    Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 01:2522.Google Scholar
  3. 3.
    Hunter Mehaffey J, Turrentine FE, Miller MS, et al. Roux-en-Y gastric bypass 10-year follow-up: the found population. Surg Obes Relat Dis. 01:124.Google Scholar
  4. 4.
    Gadiot RPM, Biter LU, van Mil S, et al. Long-term results of laparoscopic sleeve gastrectomy for morbid obesity: 5 to 8-year results. Obesity Surg. 01:271.Google Scholar
  5. 5.
    Estimate of bariatric surgery numbers, 2011-2015July,;201,710/19.Google Scholar
  6. 6.
    Dogan K, Kraaij L, Aarts EO, et al. Fast-track bariatric surgery improves perioperative care and logistics compared to conventional care. Obes Surg. 01:251.Google Scholar
  7. 7.
    Barreca M, Renzi C, Tankel J, Shalhoub J, Sengupta N. Is there a role for enhanced recovery after laparoscopic bariatric surgery? Preliminary results from a specialist obesity treatment center. Surg Obes Relat Dis. 01:121.Google Scholar
  8. 8.
    Thomas H, Agrawal S. Systematic review of 23-h (outpatient) stay laparoscopic gastric bypass surgery. J Laparoendosc Adv Surg Tech A. 01:218.Google Scholar
  9. 9.
    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. 01:132.Google Scholar
  10. 10.
    Cohn LH, Rosborough D, Fernandez J. Reducing costs and length of stay and improving efficiency and quality of care in cardiac surgery. Ann Thorac Surg. 01:646.Google Scholar
  11. 11.
    Porter GA, Pisters PWT, Mansyur C, et al. Cost and utilization impact of a clinical pathway for patients undergoing pancreaticoduodenectomy, Ann Surg Oncol. August. 01:77.Google Scholar
  12. 12.
    Hiza EA, Gottschalk MB, Umpierrez E, et al. Effect of a dedicated orthopedic advanced practice provider in a level i trauma center: analysis of length of stay and cost. J Orthop Trauma. 01:297.Google Scholar
  13. 13.
    Joseph Gholson J, Noiseux NO, Otero JE, et al. Patient factors systematically influence hospital length of stay in common orthopedic procedures. Iowa Orthop. J.;37Google Scholar
  14. 14.
    Mancuso CA, Duculan R, Craig CM, Girardi FP. Psychosocial variables contribute to length of stay and discharge destination after lumbar surgery independent of demographic and clinical variables. Spine. 9000;Publish Ahead of Print.Google Scholar
  15. 15.
    Major P, Wysocki M, Torbicz G, et al. Risk factors for prolonged length of hospital stay and readmissions after laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Obes Surg 31Google Scholar
  16. 16.
    Zacharoulis D, Sioka EF, Papamargaritis DF, et al. Influence of the learning curve on safety and efficiency of laparoscopic sleeve gastrectomy. Obesity surgery JID - 9. 106:714.Google Scholar
  17. 17.
    Mittermair R, Sucher R, Perathoner A, et al. Routine upper gastrointestinal swallow studies after laparoscopic sleeve gastrectomy are unnecessary. Am J Surg. 2076:01.Google Scholar
  18. 18.
    Mizrahi I, Tabak A, Grinbaum R, et al. The utility of routine postoperative upper gastrointestinal swallow studies following laparoscopic sleeve gastrectomy. Obesity Surg. 01:249.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of VirginiaCharlottesvilleUSA

Personalised recommendations