Renee M Tholey, MD1, Jonathan Abelson, MD1, Sara Hassen1, Daniel Benhuri2, Gregory Dakin, MD1, Alfons Pomp, MD1, Cheguevara Afaneh, MD1. 1New York Presbyterian Hospital- Weill Cornell Medical College, 2University of Toledo
INTRODUCTION: Bariatric surgery, comprised mostly of laparoscopic sleeve gastrectomy (LSG) and roux-en-y gastric bypass, is rapidly on its way to becoming the most common major general surgery procedure performed in the United States. The purpose of our study was to determine factors affecting length of stay (LOS) following LSG.
METHODS AND PROCEDURES: One hundred eighty-seven patients underwent LSG in an academic teaching hospital over two six month periods in 2013 and 2014. Patients were selected by their surgeon to undergo a routine Upper GI (UGI) study on postoperative day one (UGI group) or to proceed directly to a liquid diet without the radiographic study (No-UGI group). Primary endpoint was LOS. Secondary endpoint was surgical morbidity.
One hundred thirty-four patients were in the UGI group and fifty-three patients were in the No-UGI group. The two groups were matched for gender, age, body mass index (BMI), American Society of Anesthesiology (ASA) score, and the following preoperative co-morbidities: hypertension, diabetes mellitus, and hyperlipidemia.
RESULTS: Perioperative parameters are listed in Table 1. Postoperative complications were 8% in the UGI group and 4% in the No-UGI group (p=0.28). There were no leaks and no significant difference in 90 day readmission rates (p=0.44).
Length of stay was 58.9 hours in the UGI group and 51.4 hours in the No-UGI group (p=0.009) (Figure 1). Multivariate logistic regression analysis was used to identify independent predictors of a LOS > 48 hours. Both forward and backward stepwise regression analyses were utilized removing parameters with a P > 0.15. Variables with a P < 0.15 were included as well as ASA, BMI, and occurrence of a postoperative complication.
Performing a postoperative UGI study was the strongest predictor of a LOS > 48 hours with an odds ratio (OR) of 1.524 (p=0.01) followed by increasing ASA score (OR= 2.18, p=0.03) (Table 2).
CONCLUSIONS: We conclude that patients undergoing a postoperative UGI study are more likely to have an increased LOS as compared to those patients in the No-UGI group with no difference in surgical morbidity, leak rate, or readmission rate. Eliminating routine UGI studies following LSG is an effective strategy to decrease LOS.