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Is discharge within 1 day after gastric bypass safe? Results of a propensity-matched analysis from the MBSAQIP Participant Use File.

Julietta H Chang, MD, Elan R Witkowski, MD, MS, Matthew M Hutter, MD, MPH. Massachusetts General Hospital

Introduction: As Roux-en-Y gastric bypass (RYGB) procedures have become safer, postoperative length of stay (LOS) has decreased. Reducing LOS must be balanced by the risks of developing or recognizing postoperative complications outside of a hospital setting, and the risks of readmissions. The national average length of stay after LRYGB is 2.2 days (i.e. being discharged on POD#2), but single institution studies have shown that shorter hospital stays after surgery is safe. The MBSAQIP captures data on all cases performed at participating centers with clinically rich, standardized data collected by audited and trained clinical reviewers.  A Participant Use File with patient-level 30-day postoperative outcomes from calendar year 2015 is now available.  The objective of this study was to analyze the 30-day postoperative outcomes for patients who were discharged within 1 day after LRYGB, compared to patients who were discharged later.

Methods: Patients were categorized within two groups: those discharged within one day after surgery (POD#1 or less) vs those discharged 2-3 days after surgery (POD#2-3). Patients with LOS>3 days were excluded to minimize confounding. Patient characteristics, intraoperative data, and 30-day postoperative outcomes were analyzed with univariate analyses. Propensity matched modeling was done matching on the characteristics of patients discharged on POD#1 earlier.

Results: 45,368 nonemergent primary RYGB were performed in 2015. 37,647 (83.0%) were discharged within 3 days of surgery, of which 10,988 patients (24.2% of total) were discharged on POD#1 or earlier and 26,659 patients (58.8% of total) on POD#2-3. Unadjusted postoperative outcomes reveal decreased readmissions in the POD#1 or less group (4.75% vs 6.04%; p<0.001), as well as fewer major complications (3.15% vs 4.54%; p<0.001). Propensity-matched cohort analysis showed that rates of readmissions in the POD#1 or less group remained lower (4.74% vs 5.75%; p=0.004), as did rates of major complications (3.13% vs 4.60%; p<0.001).

Conclusion: This propensity-matched analysis of patients at MBSAQIP accredited centers reveals that early discharge after LRYGB is now being performed regularly (27% of the time), and is safe in appropriately selected patients.  Major complication rates and readmissions rates were actually decreased in patients discharged within one day.  This suggests that surgeons who discharge patients by POD#1 are identifying the right patients with an appropriate early postoperative course to discharge within one postoperative day.  It does not imply that all patients should be discharged on POD#1, or that early postoperative signs, symptoms or studies should be ignored in making the decision for discharge.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88150

Program Number: P627

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

11

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