Two-day length of stay following open Roux-En-Y gastric bypass: is it feasible, safe and reasonable?
BACKGROUND
As our bariatric program matured, we noted that length of stay (LOS) steadily decreased. This led us to analyze our experience to identify factors contributing to this abbreviated LOS and to evaluate the safety of discharging patients with only a 2-day LOS.


METHODS
All patients undergoing open Roux-en-Y gastric bypass (RYGBP) from March, 1998 to December 31, 2002 were evaluated. Contrast swallow study was performed on Day 1. Patient demographics, complications, and readmission rates were reported for all patients. Discharge criteria included adequate oral intake, pain control with oral analgesia, and an adequate understanding of the operation and its effects demonstrated by a written test before discharge.


RESULTS
316 patients underwent open RYGBP with mean BMI 52.3. Operative time decreased from 241 minutes in 1998 to 156 minutes in 2002. No patient was discharged at 2 days during the first 2 years of the program. In 2000, 1 of 52 patients (2%) went home on the second day. In 2001, the year we fully enacted our multidisciplinary approach, 14 of 96 patients (15%) returned home on the second day. In 2002, 73 of 145 patients (50%) were discharged on the second postoperative day, with no increase in readmission rates. Three of the 73 patients (4.1%) required readmission within 30 days of discharge. No difference in co-morbid diseases or BMI was noted between groups.


CONCLUSIONS
Our data support the hypothesis that patients undergoing open RYGBP can be discharged safely at Day 2, provided that aggressive preoperative education and screening are performed.
Department of Surgery, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA. tas15@po.cwru.edu
Thomas A
TA
Stellato
Peter T
PT
Hallowell
Cathy
C
Crouse
Margaret
M
Schuster
Mariana C
MC
Petrozzi
D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010351:Patient Discharge; D011183:Postoperative Complications; D011184:Postoperative Period; D016896:Treatment Outcome