Subir Sutradhar, MD, FRCSC, Ahmad Elnahas, MD, FRCSC, MSc, Simon Laplante, MD, Azusa Maeda, PhD, Allan Okrainec, MD, FRCSC, MHPE, Timothy Jackson, MD, FRCSC, MPH. Division of General Surgery, University Health Network, University of Toronto
Introduction: The safety of next-day discharge after laparoscopic sleeve gastrectomy (LSG) or laparoscopic roux-en-y gastric bypass (LRYGB) has been examined with varied results and is still a topic for debate. The objective of this study was to determine if next-day discharge after LSG or LRYGB was comparable to standard discharge (i.e. postoperative day [POD] 2) with respect to the odds of readmission and the rates of an adverse event within 30days of surgery.
Methods and Procedures: A retrospective cohort study was performed using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant Use Data File. Patients were selected if they underwent a LSG or LRYGB for morbid obesity between January 1, 2015 and December 31, 2015 and were discharged on either POD 1 or 2. The primary outcome was the odds of readmission within 30days of surgery. For each type of surgery (i.e. LSG or LRYGB), a multivariable logistic regression was performed to obtain an adjusted odds ratio (OR) of a 30-day readmission after next-day discharge. Rates of readmission, complications, reoperation, and death within 30days of surgery were also calculated.
Results: Within the LSG group, there were 44428 (52%) and 41106 (48%) patients discharged on POD 1 and 2, respectively. Both groups were comparable with respect to baseline characteristics and had equivalent rates of 30-day readmission (3%), complications (1%), reoperation (0.5%), and death (0.1%). The adjusted OR for a 30-day readmission after next-day discharge was 0.84 (p= <0.001, 95% CI [0.77-0.91]). Insulin-dependent diabetes, BMI over 50, and hypertension requiring medications were significant predictors of a readmission after next-day discharge.
Within the LRYGB group, there were 11242 (33%) and 23138 (67%) patients discharged on POD 1 and 2, respectively. Both groups had similar rates of 30-day readmission (5-6%), complications (1-2%), reoperation (1-2%), and death (0.1%). The adjusted OR for a 30-day readmission after next-day discharge was 0.89 (p=0.02, 95% CI [0.80-0.98]).
Conclusions: Based on data from the MBSAQIP registry, patients discharged on POD 1 after LSG or LRYGB did not have a higher odds of a 30-day readmission compared to the standard POD 2 group. Additionally, rates of 30-day readmission, complications, reoperation, and death were essentially equivalent. Bariatric surgeons and patients can be reassured that next-day discharge can be implemented successfully for select patients after uncomplicated LSG or LRYGB to potentially improve patient satisfaction and resource utilization, and reduce costs.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88436
Program Number: P592
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster