Safety of Same Day Discharge after Bariatric Surgery: A Retrospective Six Year North American Analysis
Tina Bharani*, Ali Tavakkoli, Malcolm K. Robinson, Eric Sheu
Department of Surgery , Brigham and Women's Hospital, Boston, MA
Objective With increasing implementation of Enhanced Recovery After Surgery protocols and rising demand for inpatient hospital beds accentuated by COVID, there has been interest in the same day discharge (SDD) for bariatric surgery. We analyzed the national trends, safety profile, and risk factors for complications of SDD for laparoscopic bariatric surgery in North America using the largest bariatric surgery database utilized by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) participating centers.
Design Retrospective cohort study of prospectively collected data.
Setting MBSAQIP data registry from 2016-2021.
Patients Patients aged "‰¥18 years undergoing primary laparoscopic or robotic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) who were discharged on POD 0 (SDD cohort) were matched 1:1 with those who were discharged on POD 1-30 (admission cohort) using demographics and pre-operative comorbidities.
Interventions: SG or RYGB
Main Outcome Measures Primary outcome included analysis of annual trends in the rate of SDD for laparoscopic bariatric surgery including SG and RYGB and comparison of post-operative outcomes within 30 days between matched SDD and admission cohorts. Secondary outcomes included identification of pre-operative factors (including demographics and medical comorbidities) associated with risk of post-operative complications for unmatched SDD cohort using multivariate logistic regression.
Results SDD for laparoscopic bariatric surgery increased by 5% over 6 years (p< 0.001). Specifically for SG, SDD increased from 3.1% to 9.7% (p<0.001); and for RYGB, SDD increased from 0.8% to 2.4% (p<0.001) over 6 years. Matching resulted in well-balanced cohorts of 32,220 subjects each in SDD and admission categories, with a comparable baseline of characteristics. A statistically significant increase in mortality within 30 days (0.11% vs 0.05%, p<0.01), cardiac arrest (0.09% vs 0.03%, p<0.01) and dehydration requiring treatment (4.99% vs 3.81%, p<0.01) were observed in SDD cohort compared to admission cohort. However, admission group had significantly more reoperations (0.92% vs 0.60%, p<0.01), readmissions (2.77% vs 2.33%, p<0.01), reinterventions (0.74% vs 0.54%, p<0.01), outpatient emergency visits (6.56% vs 5.76%, p<0.01) and overall major complications (1.82% vs 1.05%, p<0.01). Multiple logistic regression of pre-operative covariates in the unmatched SDD cohort revealed the following factors to be associated with high risk of post-operative complications (OR "‰¥1.5; p< 0.01): Black or African American race, history of MI, renal insufficiency, venous thrombosis requiring therapy and history of PE. SDD for RYGB had 72% increased risk of post-operative complications compared to SG.
Conclusion Nationally, there has been rise in SDD from 2016-2021. Risk of complications with SDD is lower for SG than RYGB. In a carefully selected patient cohort, SDD can be a safe approach.
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