title: Fast track bariatric surgery: safety of discharge on the first postoperative day after bariatric surgery.
abstract: BACKGROUND
  Fast track recovery pathways have resulted in a multidisciplinary approach to enhance postoperative recovery.
  
  
  OBJECTIVE
  To assess feasibility and outcome of early discharge after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB).
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program database was analyzed to identify patients with body mass index≥35 kg/m2who underwent LSG or LRYGB in 2012 and 2013.
  
  
  METHODS
  Patients were allocated to early discharge (ED) when discharged on postoperative (POD) 1 and late discharge (LD) when discharged on POD 2 or 3. Baseline characteristics and 30-day outcomes were compared between the 2 groups.
  
  
  RESULTS
  Records of 15,468 LSG and 16,483 LRYGB patients were analyzed; 5220 patients with LSG (33.7%) and 2960 patients with LRYGB (18%) were discharged on POD 1. The early discharge group had significantly fewer co-morbidities and lower rate of complications and readmission. Thirty-day readmission rate in LSG was 2.8% in ED versus 3.6% in LD (P = .008), and in LRGYB, it was 4.3% in ED versus 5.8% in LD (P = .001). Based on multivariate analysis, early discharge was not an independent risk factor for a higher readmission rate after LSG or LRYGB. Predictors of late discharge were age>50 years, body mass index>50 kg/m2, Hispanic or non-Hispanic black race/ethnicity, impaired functional status, diabetes on insulin, chronic steroid/immunosuppressant use, bleeding disorder, being on dialysis, chronic obstructive pulmonary disease, albumin<3.5 mg/dL, longer operative time, and concurrent cholecystectomy.
  
  
  CONCLUSIONS
  Discharge on POD 1 after LSG and LRYGB is feasible in a considerable proportion of patients. In this subgroup, early discharge is well tolerated and may be associated with lower complication and readmission rates.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Zhamak
authors.initials: Z
authors.lastname: Khorgami
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Petrosky
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Amin
authors.initials: A
authors.lastname: Andalib
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Ali
authors.initials: A
authors.lastname: Aminian
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: brethas@ccf.org.
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods* / Q000534:rehabilitation / Q000706:statistics & numerical data; D015992:Body Mass Index; D002763:Cholecystectomy / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006304:Health Status; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000534:rehabilitation / Q000601:surgery; D061646:Operative Time; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D061214:Patient Safety; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids
keywords: Early discharge; Enhanced recovery after surgery (ERAS); Fast track; Gastric bypass; NSQIP; Sleeve gastrectomy