Perioperative Outcomes of Same-Day Discharge Laparoscopic Roux-en-Y Gastric Bypass Using the MBSAQIP Database

Document Type

Conference Proceeding

Publication Date

6-27-2024

Publication Title

Surg Endosc

Keywords

accreditation, adult, anticoagulation, bariatric surgery, body mass, cohort analysis, complication, conference abstract, controlled study, coronavirus disease 2019, data base, dehydration, emergency department visit, female, hospital readmission, human, hydration, laparoscopic sleeve gastrectomy, laparoscopy, length of stay, major clinical study, male, morbidity, obstructive sleep apnea, patient selection, reoperation, Roux-en-Y gastric bypass, total quality management

Abstract

Introduction: With the increasing data on the safety of same-day discharge laparoscopic sleeve gastrectomy, there has been a growing trend to perform bariatric surgery in the outpatient setting. This trend was accelerated around the COVID-19 pandemic when healthcare resources in the inpatient setting were limited. This change in practice is gradually making its way to include laparoscopic Roux-en-Y gastric bypass (LRYGB) despite the lack of data on its safety. The aim of this study was to evaluate the safety and outcomes of same-day discharge LRYGB using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Methods: The MBSAQIP was queried for patients undergoing LRYGB from 2020 to 2021. Only cases with a length of stay of 1 day or less were included in the analysis. Two cohorts were identified: same day discharge (SDD; length of stay = 0 days) and next day discharge (POD1; length of stay = 1 day). Next day discharge cases were used as a control. The primary outcomes of interest were 30-day complications, readmissions, reoperations, emergency department visits, and treatment for dehydration. Results: A total of 48,408 patients underwent LRYGB with 1,918 (4.0%) SDD and 46,490 (96.0%) POD1. The two cohorts were similar in mean age (SDD 44.2 ± 11.3 years vs POD1 44.0 ± 11.3 years; p=0.61) and female sex (SDD 83.8% vs POD1 83.1%; p=0.43). The POD1 cohort had a higher preoperative body mass index (45.4 ± 7.3 vs 44.9 ± 7.3 kg/m2; p<0.01). Preoperative anticoagulation and obstructive sleep apnea were higher in the POD1 group. There was no difference in overall 30-day complications (SDD 2.0% vs POD1 2.3%; p=0.51), reoperations (SDD 1.0% vs POD1 1.1%; p=0.93), and emergency department visits (SDD 10.4% vs POD1 9.4%; p=0.14) between the two cohorts. Readmissions were higher in the POD1 cohort (4.0% vs 2.9%; p=0.02) whereas the need dehydration treatment was higher in the SDD cohort (6.7% vs 3.6%; p<0.01). After adjustment for confounding variables, readmissions were similar between the two cohorts whereas the need for dehydration treatment was still higher in the SDD group. Conclusion: Same-day discharge after LRYGB is not associated with increased postoperative morbidity. However, further studies are needed to better define the selection criteria for these cases as well as postoperative planning as there is an increased need for intravenous hydration therapy in these patients.

Volume

38

Issue

1

First Page

S59

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