title: Is ambulatory laparoscopic Roux-en-Y gastric bypass associated with higher adverse events?
abstract: OBJECTIVE
  To determine the impact of length of stay upon 30-day outcomes.
  
  
  BACKGROUND
  It has been recommended the goal length of stay (LOS) after laparoscopic Roux-en-Y gastric bypass (LRYGB) should be 1 day to improve resource utilization. This study's aim was to assess LRYGB outcomes by LOS.
  
  
  METHODS
  Data were obtained from the BOLD (Bariatric Outcomes Longitudinal Database) for 51,788 laparoscopic gastric bypass (LRYGB) procedures performed between 2007 and 2010. Logistic regression models were used to evaluate age, sex, race, body mass index, insurance status, comorbidities, and LOS as predictors for 30-day mortality, serious complications, and readmissions.
  
  
  RESULTS
  Overall patient demographics were as follows: median age, 45 years; median body mass index, 46.3 kg/m; % female, 78.6; % white, 77.8; % private insurance, 86.2; and % comorbidities more than 5 (39.1%). Overall, 30-day outcomes included mortality, 0.1%; serious complications, 0.5%; and readmissions, 3.8%. median LOS was 2 days, and the distribution of LOS was as follows [n (%)]: 0 (1.0), 1 (18.4), 2 (59.0), 3 (17.5), and 4 (4.1). Using the median LOS 2 days as reference, the logistic regression analysis revealed that ambulatory LOS of was significantly associated with increased risk of 30-day mortality (odds ratio: 13.02; P < 0.0001) as was LOS 1 day (odds ratio: 2.02; P < 0.0552). For LOS of 0 day, there was a trend toward an increase in the rate of 30-day serious complications (odds ratio: 1.9; P < 0.16). There was no significant trend between LOS status and 30-day readmission rates.
  
  
  CONCLUSIONS
  In this large, prospective, clinical database, LOS of 1 day or less for LRYGB patients was significantly associated with an increased risk of 30-day mortality and a trend toward increased risk of 30-day serious complications.
authors.affiliation: *Stanford University School of Medicine, Stanford, CA †American Society for Metabolic and Bariatric Surgery, Gainesville, FL ‡Scottsdale Bariatric Center, Scottsdale, AZ; and §Oregon Health Sciences University, Portland, OR.
authors.forename: John M
authors.initials: JM
authors.lastname: Morton
authors.forename: Deborah
authors.initials: D
authors.lastname: Winegar
authors.forename: Robin
authors.initials: R
authors.lastname: Blackstone
authors.forename: Bruce
authors.initials: B
authors.lastname: Wolfe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D015390:Gastric Bypass / Q000379:methods / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000401:mortality; D007902:Length of Stay; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000401:mortality / Q000601:surgery*; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D016896:Treatment Outcome; D055815:Young Adult