title: Predictors of hospital stay following laparoscopic gastric bypass: analysis of 9,593 patients from the National Surgical Quality Improvement Program.
abstract: BACKGROUND
  Bariatric centers face pressure to reduce hospitalization to contain costs, and some centers have sought to develop "fast-track" protocols. There is limited data to identify which patients require a longer hospital stay after gastric bypass, and therefore would be inappropriate for fast tracking. The objectives of this study were to determine (1) whether most patients in the United States who underwent laparoscopic gastric bypass required>1 day of hospitalization to recover; (2) whether hospital length of stay can be predicted by factors known before or after the operation.
  
  
  METHODS
  We reviewed all laparoscopic gastric bypass operations reported to the American College of Surgeons National Surgical Quality Improvement Program in 2011. Revision and open procedures were excluded. Patient and procedural characteristics, length of stay, readmissions, and 30-day morbidity and mortality were reviewed. Predictors of longer hospitalization (defined as≥3 days) were identified by multivariate analysis.
  
  
  RESULTS
  Of 9,593 laparoscopic gastric bypass operations, median length of stay was 2 days (range 0-544) and 26% of patients required≥3 days of hospitalization. In multivariate analysis, longer hospitalization was predicted by diabetes, chronic obstructive pulmonary disease, bleeding diathesis, renal insufficiency, hypoalbuminemia, prolonged operating time, and resident involvement with the procedure, but not by patient age, sex, body mass index, and other co-morbidities.
  
  
  CONCLUSIONS
  Patient characteristics and operative details predict length of hospitalization after laparoscopic gastric bypass. Such data can be used to identify patients inappropriate for fast-track protocols.
authors.affiliation: Department of Surgery, University of California-San Francisco, San Francisco, California. Electronic address: jonathan.carter@ucsfmedctr.org.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Carter
authors.affiliation: Department of Surgery, University of California-San Francisco, San Francisco, California.
authors.forename: Steven
authors.initials: S
authors.lastname: Elliott
authors.affiliation: Department of Surgery, University of California-San Francisco, San Francisco, California.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kaplan
authors.affiliation: Department of Surgery, University of California-San Francisco, San Francisco, California.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lin
authors.affiliation: Department of Surgery, University of California-San Francisco, San Francisco, California.
authors.forename: Andrew
authors.initials: A
authors.lastname: Posselt
authors.affiliation: Department of Surgery, University of California-San Francisco, San Francisco, California.
authors.forename: Stanley
authors.initials: S
authors.lastname: Rogers
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D015397:Program Evaluation; D058996:Quality Improvement; D012189:Retrospective Studies; D014481:United States
keywords: Fast track; Hospitalization; Laparoscopic gastric bypass; Length of stay; NSQIP