Reid Fletcher, MD, Rebecca Deal, John Kubasiak, Alfonso Torquati, Philip Omotosho. Rush University Medical Center
Introduction: The objective of this study was to identify patient- and procedure-related variables associated with prolonged length of stay after laparoscopic sleeve gastrectomy. Extended length of hospital stay following bariatric surgery is associated with increased health care costs and there is growing pressure to reduce length of stay after bariatric surgery. To address this issue, many bariatric centers have developed “fast-track” programs in an attempt to reduce the length of hospital stay after surgery.
Methods: Laparoscopic sleeve gastrectomy procedures reported to the American College of Surgeons National Surgical Quality Improvement Program between 2009 and 2012 were reviewed. We excluded all open procedures and revision procedures. Baseline patient characteristics, pre-operative lab values, procedural details and 30-day complications were reviewed. Logistic regression analysis was used in univariate and multivariate modes to identify patient factors that predicted prolonged hospitalization (defined as ≥ 3 days). Pre-operative patient characteristics with a P value less than 0.1 were entered into logistic regression using conditional stepwise method. The logistic regression analysis was computed with a 95% confidence interval and expressed as an odds ratio. The Stata 13 statistical software program (StataCorp. 2013. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP.) was used in our analysis.
Results: We identified 11,430 patients who underwent laparoscopic sleeve gastrectomy. The median length of stay was 2 days (range 0-369) and 18.4% required hospitalization ≥ 3 days. Multivariate analysis revealed that female sex (OR 1.49), age greater than 65 (OR 2.19), body mass index greater than 50 (OR 1.44), pre-operative functional status (OR 7.80), chronic obstructive pulmonary disease (OR 2.20), hypertension (OR 1.27), renal insufficiency (OR 1.69), anemia (OR 1.39), and prolonged operative time (OR 2.53) were significantly associated with prolonged hospital stay.
Conclusion: Pre-operative patient characteristics as well as operative details predict prolonged length of stay following laparoscopic sleeve gastrectomy. As the utilization of fast-track protocols in bariatric surgery programs expands, these data may be used to assist in the selection of patients who may be inappropriate for rapid discharge from the hospital after sleeve gastrectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79208
Program Number: P544
Presentation Session: Poster (Non CME)
Presentation Type: Poster