Abstract
Background
There is controversy surrounding the safety and feasibility of next-day discharge following laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity. The objective of this study was to determine if next-day discharge following LRYGB is comparable to standard discharge (i.e. postoperative day two) with respect to 30-day patient outcomes.
Methods
A retrospective cohort analysis was performed using data from the American College of Surgeons’ National Surgery Quality Improvement Program participant use files. The study population consisted of patients discharged on either postoperative day (POD) 1 or 2 that underwent an elective LRYGB for morbid obesity between 2005 and 2012. Patients were excluded if they had recent surgery, any relative contraindication to bariatric surgery, or any recorded complication/death during their principal admission. The primary outcome was 30-day overall complications and secondary outcomes were 30-day major complications and reoperations. A multiple logistic regression analysis was performed to evaluate each outcome based on discharge day.
Results
The study population consisted of 6,166 and 30,966 patients discharged on POD 1 and 2, respectively. No major clinical differences were found between the two groups with respect to relevant patient and operative characteristics. After adjustment, the odds ratios for 30-day overall complications, major complications, and reoperations with next-day discharge were 0.98 (p = 0.870, 95 % CI [0.81–1.19]), 0.81 (p = 0.204, 95 % CI [0.58–1.12]) and 1.06 (p = 0.717, 95 % CI [0.79–1.41]), respectively. Body mass index ≥50, operative time ≥3 h, diabetes, dyspnea and hypertension were significant predictors for complications in patients discharged the next day.
Conclusions
Using this large national surgical database, LRYGB patients discharged on POD 1 did not have a significantly higher rate of adverse events compared to patients discharged on POD 2. Understanding the important predictors of adverse events following LRYGB will help bariatric surgeons implement next-day discharge protocols based on the appropriate perioperative evaluation.
Similar content being viewed by others
References
Mccarty TM, Arnold DT, Lamont JP, Fisher TL, Kuhn JA (2005) Optimizing outcomes in bariatric surgery: outpatient laparoscopic gastric bypass. Ann Surg 242(4):494–501
Hollenbeak CS, Rogers AM, Barrus B, Wadiwala I, Cooney RN (2008) Surgical volume impacts bariatric surgery mortality: a case for centers of excellence. Surgery 144(5):736–743
Tuggle KR, Duncan TD, Hobson LL, Carr A, Sans K (2011) Is 23 hour observation for gastric bypass surgery safe? Obesity Surgery. In: Conference: 16th congress of the international federation for the surgery of obesity and metabolic disorders, IFSO 2011 Hamburg, Germany vol 21, issue 8, p 1103
Sasse KC, Ganser JH, Kozar MD, Watson RW, Lim DC, Mcginley L, Smith CJ, Bovee V, Beh J (2009) Outpatient weight loss surgery: initiating a gastric bypass and gastric banding ambulatory weight loss surgery center. J Laparoendosc Adv Surg Tech A 13(1):50–55
Thomas H, Agrawal S (2011) Systematic review of 23-h (outpatient) stay laparoscopic gastric bypass surgery. J Laparoendosc Adv Surg Tech A 21(8):677–681
Fares LG, Reeder RC, Bock J, Batezel V (2008) 23-h stay outcomes for laparoscopic roux-en-y gastric bypass in a small, teaching community hospital. Am Surg 74(12):1206–1210
Morton JM, Winegar D, Blackstone R, Wolfe B (2014) Is ambulatory laparoscopic Roux-En-Y gastric bypass associated with higher adverse events? Ann Surg 259(2):286–292
Khuri SF, Henderson WG, Daley J (2007) The patient safety in surgery study: background, study design, and patient populations. J Am Coll Surg 204(6):1089–1102
Khuri SF, Daley J, Henderson W (1997) Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg 185(4):315–327
Daley J, Khuri SF, Henderson W (1997) Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg 185(4):328–340
Daley J, Forbes MG, Young GJ (1997) Validating risk-adjusted surgical outcomes: site visit assessment of process and structure National VA Surgical Risk Study. J Am Coll Surg 185(4):341–351
Khuri SF, Henderson WG, Daley J (2008) Successful implementation of the Department of Veterans Affairs’ National Surgical Quality Improvement Program in the private sector: the patient safety in surgery study. Ann Surg 248(2):329–336
Finks J, Dimick J, English W, Carlin A, Hawasli A, Wood M, Genaw J, Share D, Birkmeyer J, Birkmeyer NJ (2012) Effects of early discharge on morbidity, mortality, ED visits and readmissions following laparoscopic gastric bypass: results from the Michigan Bariatric Surgery Collaborative.In: 29th annual meeting of the American society for metabolic and bariatric surgery (ASMBS 2012), San Diego. Plenary Session Abstract PL-132
Courcoulas A, Schuchert M, Gatti G, Luketich J (2003) The relationship of surgeon and hospital volume to outcome after gastric bypass surgery in pennsylvania: a 3-year summary. Surgery 134(4):613–621
Dos santos M, Madalosso CA, Palma LA, Da silva Fornari AC, Do Socorro D, Scherer T, Gurski RR, Fornari F (2009) Hospital discharge in the day following open roux-en-y gastric bypass: is it feasible and safe? Obes Surg 19(3):281–286
Madan AK, Speck KE, Ternovits CA, Tichansky DS (2006) Outcome of a clinical pathway for discharge within 48 h after laparoscopic gastric bypass. Am J Surg 192(3):399–402
Muller MK, Dedes KJ, Dindo D, Steiner S, Hahnloser D, Clavien PA (2009) Impact of clinical pathways in surgery. Langenbecks Arch Surg 394(1):31–39
Ronellenfitsch U, Schwarzbach M, Kring A, Kienle P, Post S, Hasenberg T (2012) The effect of clinical pathways for bariatric surgery on perioperative quality of care. Obes Surg 22(5):732–739
Lancaster RT, Hutter MM (2008) 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 22(12):256–2554
Acknowledgments
The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein.
Disclosures
There are no conflicts of interests to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Elnahas, A., Urbach, D., Okrainec, A. et al. Is next-day discharge following laparoscopic Roux-en-Y gastric bypass safe in select patients? Analysis of short-term outcomes. Surg Endosc 28, 2789–2794 (2014). https://doi.org/10.1007/s00464-014-3546-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-014-3546-2