Is next-day discharge following laparoscopic Roux-en-Y gastric bypass safe in select patients? Analysis of short-term outcomes.
BACKGROUND
There is controversy surrounding the safety and feasibility of next-day discharge following laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity. The objective of this study was to determine if next-day discharge following LRYGB is comparable to standard discharge (i.e. postoperative day two) with respect to 30-day patient outcomes.


METHODS
A retrospective cohort analysis was performed using data from the American College of Surgeons' National Surgery Quality Improvement Program participant use files. The study population consisted of patients discharged on either postoperative day (POD) 1 or 2 that underwent an elective LRYGB for morbid obesity between 2005 and 2012. Patients were excluded if they had recent surgery, any relative contraindication to bariatric surgery, or any recorded complication/death during their principal admission. The primary outcome was 30-day overall complications and secondary outcomes were 30-day major complications and reoperations. A multiple logistic regression analysis was performed to evaluate each outcome based on discharge day.


RESULTS
The study population consisted of 6,166 and 30,966 patients discharged on POD 1 and 2, respectively. No major clinical differences were found between the two groups with respect to relevant patient and operative characteristics. After adjustment, the odds ratios for 30-day overall complications, major complications, and reoperations with next-day discharge were 0.98 (p = 0.870, 95% CI [0.81-1.19]), 0.81 (p = 0.204, 95% CI [0.58-1.12]) and 1.06 (p = 0.717, 95% CI [0.79-1.41]), respectively. Body mass index ≥50, operative time ≥3 h, diabetes, dyspnea and hypertension were significant predictors for complications in patients discharged the next day.


CONCLUSIONS
Using this large national surgical database, LRYGB patients discharged on POD 1 did not have a significantly higher rate of adverse events compared to patients discharged on POD 2. Understanding the important predictors of adverse events following LRYGB will help bariatric surgeons implement next-day discharge protocols based on the appropriate perioperative evaluation.
University Health Network, Division of General Surgery, Department of Surgery, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada, ahmadelnahas@gmail.com.
Ahmad
A
Elnahas
David
D
Urbach
Allan
A
Okrainec
Fayez
F
Quereshy
Timothy D
TD
Jackson
D000328:Adult; D015992:Body Mass Index; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D004417:Dyspnea / Q000453:epidemiology; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D010535:Laparoscopy; D008297:Male; D061646:Operative Time; D010351:Patient Discharge; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology