Fast track bariatric surgery: safety of discharge on the first postoperative day after bariatric surgery

Surg Obes Relat Dis. 2017 Feb;13(2):273-280. doi: 10.1016/j.soard.2016.01.034. Epub 2016 Feb 2.

Abstract

Background: Fast track recovery pathways have resulted in a multidisciplinary approach to enhance postoperative recovery.

Objectives: To assess feasibility and outcome of early discharge after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB).

Setting: The American College of Surgeons National Surgical Quality Improvement Program database was analyzed to identify patients with body mass index≥35 kg/m2 who underwent LSG or LRYGB in 2012 and 2013.

Methods: Patients were allocated to early discharge (ED) when discharged on postoperative (POD) 1 and late discharge (LD) when discharged on POD 2 or 3. Baseline characteristics and 30-day outcomes were compared between the 2 groups.

Results: Records of 15,468 LSG and 16,483 LRYGB patients were analyzed; 5220 patients with LSG (33.7%) and 2960 patients with LRYGB (18%) were discharged on POD 1. The early discharge group had significantly fewer co-morbidities and lower rate of complications and readmission. Thirty-day readmission rate in LSG was 2.8% in ED versus 3.6% in LD (P = .008), and in LRGYB, it was 4.3% in ED versus 5.8% in LD (P = .001). Based on multivariate analysis, early discharge was not an independent risk factor for a higher readmission rate after LSG or LRYGB. Predictors of late discharge were age>50 years, body mass index>50 kg/m2, Hispanic or non-Hispanic black race/ethnicity, impaired functional status, diabetes on insulin, chronic steroid/immunosuppressant use, bleeding disorder, being on dialysis, chronic obstructive pulmonary disease, albumin<3.5 mg/dL, longer operative time, and concurrent cholecystectomy.

Conclusion: Discharge on POD 1 after LSG and LRYGB is feasible in a considerable proportion of patients. In this subgroup, early discharge is well tolerated and may be associated with lower complication and readmission rates.

Keywords: Early discharge; Enhanced recovery after surgery (ERAS); Fast track; Gastric bypass; NSQIP; Sleeve gastrectomy.

Publication types

  • Comparative Study
  • Evaluation Study
  • Multicenter Study

MeSH terms

  • Adult
  • Bariatric Surgery / methods*
  • Bariatric Surgery / rehabilitation
  • Bariatric Surgery / statistics & numerical data
  • Body Mass Index
  • Cholecystectomy / statistics & numerical data
  • Feasibility Studies
  • Female
  • Health Status
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Length of Stay / statistics & numerical data
  • Male
  • Obesity, Morbid / complications
  • Obesity, Morbid / rehabilitation
  • Obesity, Morbid / surgery
  • Operative Time
  • Patient Discharge*
  • Patient Readmission / statistics & numerical data
  • Patient Safety
  • Postoperative Care / methods
  • Postoperative Complications / etiology
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / complications
  • Renal Dialysis / statistics & numerical data
  • Risk Factors
  • Steroids / therapeutic use

Substances

  • Immunosuppressive Agents
  • Steroids