title: Safety of next-day discharge following laparoscopic sleeve gastrectomy.
abstract: BACKGROUND
  The safety of next-day discharge after laparoscopic sleeve gastrectomy (SG) for the treatment of morbid obesity has not been well studied. The objective of this study was to determine if next-day discharge after laparoscopic SG was comparable to standard discharge (i.e., postoperative day [POD] 2) with respect to the rate of 30-day adverse events.
  
  
  METHODS
  A retrospective cohort analysis was performed. Patients were selected if they underwent a laparoscopic SG for morbid obesity between 2010 and 2012 and discharged on either POD 1 or 2. The primary outcome was the 30-day adverse event rate, which was a composite endpoint of complications, mortality, or reoperations. A multivariable logistic regression was performed to determine an adjusted odds ratio (OR) of 30-adverse events for next-day discharge.
  
  
  RESULTS
  There were 2982 (37.4%) and 4985 (62.6%) patients discharged on POD 1 and 2, respectively. Both groups were comparable with respect to clinical characteristics. The adjusted OR for 30-day adverse events with next-day discharge was .75 (P = .08, 95% CI [.55-1.04]). Preoperative hypertension and dyspnea were significant predictors of adverse events for next-day discharge.
  
  
  CONCLUSIONS
  Based on data from the ACS-NSQIP registry, laparoscopic SG patients discharged on POD 1 did not have a worse rate of 30-day adverse events compared to the POD 2 group. Appropriate perioperative evaluation may help surgeons implement next-day discharge for select patients after uncomplicated laparoscopic SG.
authors.affiliation: Division of General Surgery, University Health Network, Toronto, Ontario, Canada.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Elnahas
authors.affiliation: Division of General Surgery, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
authors.affiliation: Division of General Surgery, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Fayez A
authors.initials: FA
authors.lastname: Quereshy
authors.affiliation: Division of General Surgery, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: Timothy.Jackson@uhn.ca.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Jackson
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D010351:Patient Discharge / Q000639:trends*; D061214:Patient Safety; D011184:Postoperative Period; D012189:Retrospective Studies
keywords: Laparoscopic sleeve gastrectomy; Morbid obesity; Next-day discharge