Abstract
Background
Previous studies have evaluated the safety of post-operative day one (POD #1) discharge after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Few studies, however, have evaluated the impact of a standardized POD #1 discharge pathway on peri-operative outcomes. This study aims to evaluate peri-operative outcomes after implementation of an enhanced recovery pathway for RYGB patients.
Methods
Data from a prospectively maintained database identified 2,049 patients (pre-implementation n = 904; post-implementation n = 1,144) who underwent LRYGB between 2008 and 2016. The POD1 discharge pathway was implemented in July 2011. Patient demographics and outcomes before and after implementation of the POD1 pathway were compared using univariate analysis and propensity matching.
Results
A propensity-matched group of all patients (n = 714) and POD #1 candidates (n = 490) pre- and post-pathway implementation were analyzed. Successful POD #1 discharges were significantly increased after introduction of the pathway (54.3 vs 17.8%, p < 0.0001). The post-implementation groups demonstrated no differences in mortality, Emergency department (ED) visits, readmissions, reoperations, and major or minor complications.
Conclusions
Early discharge after bariatric surgery has a significant impact on the cost effectiveness of surgery, patient comfort, potential reduction of medical errors, and exposure to hospital-acquired infections. Our results demonstrate that a standardized POD #1 discharge pathway can be safely implemented and in turn, reduce hospital LOS without negatively affecting peri-operative morbidity, mortality, ED visit, readmission, or reoperation rates.
Similar content being viewed by others
References
McCarty TM, Arnold DT, Lamont JP, Fisher TL, Kuhn JA. Optimizing outcomes in bariatric surgery. Transactions of the Meeting of the American Surgical Association 2005;123(&NA;):188–195. doi:https://doi.org/10.1097/01.sla.0000183354.66073.4c.
Milliman’s Care Guidelines, 14th Ed, 2010.
Morton JM, Garg T, Nguyen N. Does hospital accreditation impact bariatric surgery safety? Ann Surg. 2014;260(3):504–9. https://doi.org/10.1097/sla.0000000000000891.
Geubbels N, Bruin SC, Acherman YIZ, et al. Fast track Care for Gastric Bypass Patients Decreases Length of stay without increasing complications in an unselected patient cohort. Obes Surg. 2013;24(3):390–6. https://doi.org/10.1007/s11695-013-1133-6.
Hahl T, Peromaa-Haavisto P, Tarkiainen P, et al. Outcome of laparoscopic gastric bypass (LRYGB) with a program for enhanced recovery after surgery (ERAS). Obes Surg. 2015;26(3):505–11. https://doi.org/10.1007/s11695-015-1799-z.
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.
Lois AW, Frelich MJ, Sahr NA, et al. The relationship between duration of stay and readmissions in patients undergoing bariatric surgery. Surgery. 2015;158(2):501–7. https://doi.org/10.1016/j.surg.2015.03.051.
Rickey J, Gersin K, Yang W, et al. Early discharge in the bariatric population does not increase post-discharge resource utilization. Surg Endosc. 2016;31(2):618–24. https://doi.org/10.1007/s00464-016-5006-7.
Petrick AT. Preventing readmissions: Geisinger: how we do it. Surg Obes Relat Dis. 2014;10(3):392–5. https://doi.org/10.1016/j.soard.2014.02.035.
Pope GD, Birkmeyer JD, Finlayson SR. National trends in utilization and in-hospital outcomes of bariatric surgery. J Gastrointest Surg. 2002;6(6):855–60.
Khorgami Z, Andalib A, Aminian A, et al. Predictors of readmission after laparoscopic gastric bypass and sleeve gastrectomy: a comparative analysis of ACS-NSQIP database. Surg Endosc. 2016;30(6):2342–50. https://doi.org/10.1007/s00464-015-4477-2.
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.
Benotti P, Wood GC, Winegar DA, et al. Risk factors associated with mortality after Roux-en-Y gastric bypass surgery. Ann Surg. 2013;00(00):1–8.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval
For this type of study, formal consent is not required.
Informed Consent
Does not apply.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Buzalewski, J.M., Mahan, M.E., Fluck, M. et al. Equivalent Peri-Operative Outcomes for Laparoscopic Roux-En-Y Gastric Bypass Patients Discharged on Post-Operative Day One. OBES SURG 29, 2392–2398 (2019). https://doi.org/10.1007/s11695-019-03884-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-019-03884-7