Jessica Ardila-Gatas, MD, Gautam Sharma, MD, S. Julie-Ann Lloyd, MD, PhD, Philip R Schauer, MD, Stacy A Brethauer, MD, Ali Aminian, MD. Cleveland Clinic
Introduction: Introduction of enhanced recovery after surgery (ERAS) pathways has led to early recovery and shorter hospital stay after Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) and Laparoscopic Sleeve Gastrectomy (LSG). This study aims to assess feasibility and outcomes of postoperative day (POD) 1 discharge after LRYGB and LSG from a national database.
Methods: Patients who underwent elective primary LRYGB and LSG and were discharged on POD 1 and 2 were extracted from Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) 2015 dataset. A 1:1 propensity score matching was performed between cases with POD1 vs POD2 discharge, and the 30-day outcomes of the propensity-matched cohorts were compared. High risk patients were excluded from the analysis.
Results: In total, 80,464 patients met inclusion criteria, and included 8,862 LRYGB and 31,370 LSG cases which were discharged on POD1, and were matched with same number of patients per group that were discharged on POD2. Both groups have similar preoperative characteristics. Within the LRYGB cohort, patients discharged on POD2 had higher all cause morbidity (composite of 26 adverse events, 7.5% vs 6.1%; p<0.001) and 30-days re-intervention (2.0% vs 1.5%; p=0.004) in comparison to patients discharged on POD1. There were no statistical differences with respect to serious morbidity (defined as class IV or V Clavien-Dindo complication, 0.5% vs 0.4%; p=0.15), 30-day readmission (4.9% vs 4.5%; p=0.2) and 30-day reoperation (1.3% vs 1.2%; p=0.7). Within the LSG cohort, patients discharged on POD2 had higher all cause morbidity (4.2% vs 3.4%; p<0.001), serious morbidity (0.4% vs 0.3%; p<0.001), 30-day re-interventions (1.0% vs 0.6%%; p=<0.001), and 30-day readmission (2.9% vs 2.5%; p=0.002) in comparison to patients discharged on POD1. There were no statistical differences with respect to 30-day reoperation (0.5% vs 0.6%; p=0.17).
Conclusion: Based on available national data, early postoperative outcomes of selected patients discharged on POD1 after LSG and LRYGB were not worse than those discharged on POD2. Early discharge on POD1 may be safe in a selective group of bariatric patients without significant co-morbidities.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88139
Program Number: P581
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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