Hatim A Alsulaim, MD, MPH, Aslam Ejaz, MD, MPH, Robin D Megill, MSPH, Liyang Tang, BA, Michael A Schweitzer, MD, FACS, Thomas H Magnuson, MD, FACS, Kimberley E Steele, MD, PhD, FACS. Department of Surgery, The Johns Hopkins University School of Medicine
Introduction: Reducing hospital length of stay (LOS) is a goal for minimizing resource utilization and costs following bariatric surgery. We aimed to compare post-operative outcomes between patients who had early (LOS≤ 1 day) and standard discharge (LOS>1 day) and to identify factors associated with early discharge after bariatric surgery.
Methods: We performed a retrospective analysis of 1,226 patients ≥18 years of age who underwent sleeve gastrectomy (VSG) or Roux-en-Y gastric bypass (RYGBP) between November 2009 and July 2015 at our institution. Patient demographics, pre-operative body mass index (BMI), pre-surgical comorbidities, LOS, and excess weight loss percentages (%EWL) were recorded. Postoperative morbidity included nausea, vomiting, dehydration, wound complication, leak, ulcer, incisional hernia and small bowel obstruction. We defined early discharge as patients with LOS ≤ 1 day. Predictors and post-operative outcomes associated with early discharge were identified by multivariable analysis using univariable and multivariable logistic regression models.
Results: Overall median age was 43 years (IQR: 35, 52). The majority of patients were female (n=959, 78.2%) and Caucasian (n=827, 67.46%). Most patients had multiple comorbidities (n=728, 59.38%), most commonly hypertension (n=715, 58.32%), diabetes (n=359, 29.28%), and gastroesophageal reflux disease (GERD) (n=430, 35.07%). The overall mean pre-operative BMI mean was 48.51 ± 10 kg/m2. Mean LOS was 2.74 ± 1.9 days and was longer among patients undergoing RYGBP (2.97 ± 2.29) as compared to VSG (2.41 ± 1.14) (P<0.001). Sixty-six patients (5.4%) had an early discharge. Patients with an early discharge were more likely to have undergone a laparoscopic operation (laparoscopic: n=63, 95.45% vs. open: n=3, 4.55%; P=0.005), VSG (VSG: n=53, 80.30% vs. RYGBP: n=13, 19.70%; P=<0.001) but less likely have pre-op GERD (GERD: n=13, 19.70% vs. no GERD: 53, 80.30%; P=0.007). Patient characteristics such as age, sex, BMI, race, insurance status, and co-morbidities other than GERD were not associated with early discharge (all P>0.05). Post-operative morbidity and readmission within 30 days did not differ between those with or without an early discharge (all P>0.05). After controlling for all factors, VSG (OR 6.90, P=<0.001) and pre op GERD (OR 0.53, P=0.050) were the only independent factors associated with early discharge.
Discussion: Patients who undergo VSG and those without preoperative GERD are more likely to be discharged early. There is no association between early discharge and postoperative morbidity or readmission. Further larger studies are needed to identify which factors are associated with increased resource utilization following bariatric surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79715
Program Number: P556
Presentation Session: Poster (Non CME)
Presentation Type: Poster