Sepehr Lalezari, MD1, Matthew C Musielak, MD2, Lisa A Broun, CNP2, Trace W Curry, MD2. 1Johns Hopkins Medicine, 2The Jewish Hospital, Cincinnati
INTRODUCTION: Laparoscopic sleeve gastrectomy is becoming one of the most commonly performed abdominal operations in the United States. With rising health care costs and its inherent economic burden, safe and viable options to reduce cost must be sought. We present our experience with same day discharge after laparoscopic sleeve gastrectomy on 737 patients from 2011-2015. This is the largest series of patients undergoing ambulatory surgery for such a procedure published to date.
MATERIALS AND PROCEDURES: Retrospective review of the medical record of all patients undergoing ambulatory laparoscopic sleeve gastrectomy performed by a single surgeon from January 2011 to April 2015. Incidence of readmission was evaluated. All patients were discharged from an ambulatory surgery center on the same day of surgery without an overnight stay in the hospital.
RESULTS: Of the 205 patients reviewed thus far the incidence of 30-day readmissions is 1.5%. A leak at the staple line was noted in 2/205 patients and a pelvic abscess without evidence of leak was noted in 1/205 patients.
DISCUSSION: Same day surgery is performed on a wide range of laparoscopic procedures. In bariatric surgery the most commonly performed outpatient surgery is an adjustable gastric band. The literature reports a 0.5-2.6% rate of readmission with gastric banding. To date only a two studies can be found in the literature regarding same day discharge after laparoscopic sleeve gastrectomy. In a recent study by Rebibo et al. gastric leak was also the most common cause for hospital readmission. In the second study by Billing et al. the most common cause appears to be related to hypoxia from untreated or improperly treated sleep apnea. In these two studies the readmission rates were 7% and 3.6% respectively. The most common cause of readmission in our series is a leak at the staple line which usually does not present until post-operative day five. Although unlikely, this raises the question as to whether the leak would have been prevented by an overnight admission and stay in the hospital. Furthermore, with a low overall readmission rate portends to the feasibility of laparoscopic sleeve gastrectomy as a safe outpatient procedure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79503
Program Number: S128
Presentation Session: Bariatric surgery – Sleeves, Conversions and More
Presentation Type: Podium
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